NO YES NO YES YES NO NO AWS

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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. COACH AND STAFF REGISTRATION FORM. MANDATORY □ Coach Certification.

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: ________________________________________________________________

DATE:

____________

REQUESTOR'S SIGNATURE: ______________________________________________________________________

DATE:

____________

CLUB LEADERS APPROVAL SIGNATURE: ______________________________________________________________

DATE:

____________

FOR LEAGUE USE ONLY HEAD COACH CHEER COACH:

MANDATORY

ASSISTANT COACH ASSISTANT CHEER COACH:

MANDATORY

OTHER STAFF:



MANDATORY



APPROVED

DECLINED

L-1

DB

Coach Certification Coach Certification Background Check

□ □

Background Check Background Check

OPTIONAL



1st Aid/CPR

OPTIONAL

□ Coach Certification

□ □

1st Aid/CPR

1st Aid/CPR

REASON: _____________________________________________________________________

CERTIFICATION COMP DATE: _____________ QB

□ □ □

BC APPROVAL DATE:________________ APPEAL COMPLETION: DATE & NOTES

BADGE ISSUE DATE: _________________

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