Coach Screening Application

2. First Name

3. Last Name

5. Address

7. City

8. State

9. Zip Code

11. Phone Number

13. Email Address

15. I have been criminally convicted or have charges pending for:*

    1. Felony homicide
    2. Sexual assault of any kind
    3. Physically or sexually abusing a minor
    4. Exploiting a minor
    5. Threats of violence
    6. Sale or distribution of controlled substance
    7. None of the above
16. I have had a criminal felony conviction within the last 10 years*

    1. Yes
    2. No
18. I was incarcerated in federal or state prison in the last 5 years*

    1. Yes
    2. No
19. I am now on parole/probation to any court, penal institution, or govt. entity, including being under house arrest or subject to a tracking device*

    1. Yes
    2. No

21. I was criminally convicted of a misdemeanor in the last 7 years involving*

    1. A crime of moral turpitude
    2. Violent or aggravated conduct with persons or property
    3. None of the above

22. I was criminally convicted of a misdemeanor in the last 3 years involving*

    1. A crime of moral turpitude
    2. Violent or aggravated conduct with persons or property
    3. DUI, DWI or related offense
    4. None of the above
24. I have an outstanding arrest warrant from any jurisdiction*

    1. Yes
    2. No

25. I am now subject to a protective order for physical or sexual abuse*

    1. Yes
    2. No

27. League or division you are volunteering to coach for*

    Include grade, age and gender

29. What are you applying to be?

    1. Head Coach
    2. Assistant Coach

30. Sport I am applying to coach*
    -- Select One --BaseballBasketballFlag FootballFootballSoftballSoccer

32. Coaching Experience*

34. Players to freeze (2) or (3) depending on sport/age division*

    Must include your child. Basketball, flag football and draft division baseball/softball you may freeze 2 players. Soccer and baseball/softball ages 10 and younger you may freeze 3 players. Please read the WFFL By-laws regarding tackle football. High School age sports may have special rules. If you are coaching a division that includes High School age players please see the coordinator of the sport for details. We will compose your roster considering frozen players area schools. Frozen players must be registered within the registration period. To view additional details regarding team composition visit our “Policies and Forms” page on our website www.kaysvillerec.com

36. What school does your child attend?

38. As a coach I will comply with the following code of ethics:

    1. I will remember that I am a youth coach, and that the game is for the PLAYERS and not the adults
    2. I will do my very best to make this sport FUN for my players
    3. I will place the emotional and physical well-being of my players ahead of any personal desire to win
    4. I will remember to treat every player as an individual, listening to their needs, remembering the large range of emotional and physical development for the age group
    5. I will refrain from physically contacting players, other coaches, fans or officials, etc
    6. I will do my very best to provide a safe play situation for my players not only physically, but mentally. I WILL REFRAIN FROM SWEARING AND THE USE OF VULGAR TERMS
    7. I will insure that I am knowledgeable in the rules of this sport, and that I will teach these rules to my players and play by those rules in every game
    8. I will lead by example, and demonstrate GOOD SPORTSMANSHIP, FAIR PLAY and CONDUCT to all my players, their parents, officials, and the opposing team and recreation staff at every practice and game.
    9. I will ask my players to treat other players, coaches, fans, officials and recreation staff with respect regardless of race, sex, creed or ability
    10. I will refrain from smoking or the use of any form of tobacco on or in the vicinity of the playing area. I will also refrain from any alcoholic beverages or use of any drugs when I am around players
    11. Failure to comply with any part of this Code of Ethics may result in dismissal as volunteer coach. This will be determined by the recreation staff

40. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. I, the undersigned, do hereby verify, under penalty of perjury, that the information provided herewith is complete, truthful and accurate to the best of my knowledge and belief. I do hereby agree to allow the City to obtain a name/date of birth BCI background check for enforcement purposes. I understand and agree that the League Director has the discretion to choose who will manage/coach. I accept that the League Director has the discretion to suspend or expel a coach for improper conduct.

    1. I agree.
42. Electronic Signature

Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field