COACH AND STAFF REGISTRATION FORM PERSONAL INFORMATION
NAME:
CLUB NAME
FULL ADDRESS: EMAIL ADDRESS: CELL PHONE #:
HOME PHONE #:
WORK PHONE #:
DL - STATE, NUMBER & EXP (include copy with application):
□ YES
PREVIOUS YEAR STAFF MEMBER:
□ □
□ NO
DIVISION(S) (circle all applicable): MM MINOR (under 18 yrs):
JPW
□ NO
PW
□ YES
JR
CHEER
IF YES, INDICATE AGE: ______
STAFF POSITION REQUESTED - A Background Check is Required for All Positions HEAD COACH BUSS MGR/TREASURER
□ □
ASSISTANT COACH CHEER COACH
□ □
□ □
TEAM MOM ASST CHEER COACH
□ □
STATS EQUIPMENT
WATER PHOTOGRAPHER
*** All minors on sidelines must be included in the team's 10 issued badges regardless of position with the team. Minor applicants are not required to complete a background check - age verification may be requested prior to approval.
FOOTBALL COACHING EXPERIENCE
PAST FOOTBALL COACHING OR STAFF POSITIONS (YEARS AND POSITIONS): OTHER SPORTS YOU HAVE COACHED AND LOCATIONS: LIST TWO REFERENCES AND THEIR CONTACT PHONE #: 1
2
HAVE YOU EVER BEEN DISMISSED FROM A COACHING POSITION? IF YES, EXPLAIN WHY:
□ NO □
YES
HAVE YOU EVER BEEN EJECTED FROM A SPORTING EVENT YOU WERE COACHING, INCLUDING ALLIANCE? IF YES, EXPLAIN WHY:
□ NO □
YES
_____ I understand that I must fill out the INFORMATION section in its entirety. A badge will not be issued if any field in the
INFORMATION section is not complete and accurate information or if this form is not clear and legible.
_____ I understand I must complete all mandatory requirements for a requesed position in order to be issued a badge. All data and certifications will be independently reviewed and verified by an Alliance Youth Sports Association staff member. _____ I understand that a maximum of 10 badges per team will be issued for any given season. All badge requests must be approved by the league. A fee of $10 for replacement badges may apply. ____ I understand that completion of this form and any certification requirements does not in any way guarantee the approval for badge. STAFF MEMBER PRINTED NAME: ________________________________________________________________