SHILOH YOUTH ATHLETIC ASSOCIATION

FOOTBALLCOACH APPLICATION

Completion of this form does not guarantee that a coaching position will be available.

Placement of coaches will be made by the Softball Commissioner & the Softball Board based on the number of teams.

Full Name
Street Address
City / Zip
Mailing Address (if different from above)
City / Zip
Home Phone / Work Phone / Mobile Phone
Email
Emergency Contact / Relationship / Phone

Are you 18 years or older: ______

Do you have a valid driver’s license: ______

Have you had First Aide, CPR or AED training: Y or N Expiration?______

1. Would you like to be a Head Coach or Assistant Coach? ______

2. Which age group you would like to work with? ______

3. Do you have a child in this age group? ______

4. Do you have any other children in our program? ______

4a. How many children? _____ Baseball, _____Softball, other ______

5. List your personal sports and recreation experience:

______

______

______

6. List your previous coaching experience and/or work with children:

______

______

______

7. Please list other skills, which qualify you as a youth coach:

______

______

______

8. Have you ever coached with any other association within the Gwinnett

County or surrounding community?

a. If yes, which association: ______

b. Were you a head coach or assistant coach? ______

c. Why did you choose to leave them? ______

______

______

d. Please list the name and phone number of two references from that

Association:

1. ______

2. ______

9. Please list the name and phone numbers for 3 personal references:

1. ______

2. ______

3. ______

I certify that as a volunteer youth coach:

1. I have no criminal convictions.

2. I will place the well-being of my players ahead of my personal desire to win.

3. I will do my best to provide safe practice and playing situation.

4. I will lead, by example, in demonstrating fair play and good sportsmanship to all players, officials and coaches.

5. I will be sure that I am knowledgeable of the rules of the program and willteach them to my players.

6. I will remember that I am a YOUTH coach and that the game is for the childrenand not the adults.

Authorization and Release of Information

I hereby authorize and request Shiloh Youth Athletic Association to obtain anypolice records, including the records of arrest, police reports, accident reportsand records of convictions including both misdemeanors and felonies, for thesole purpose of coaching youth sports.

I understand that the giving of this authorization and release of information is acondition of volunteering with the Shiloh Youth Athletic Association and anyapplicant who does not execute this release shall not be allowed to coach ayouth team.

My signature below certifies that all of the information on this application isaccurate and that I agree to its terms.

______

(Signature) (Date)

All completed Coaches Applications shall be returned to the Football

Commissioner at