Spalding Basketball Association

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Volunteer Coach Application

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

Cell Number:

* Birthdate:

Email:

* Driver's License #:

* Social Security #:

* Occupation:

* Employer:

* Employer's Address:

* I would like to volunteer as a:

* Did you Coach a SBA team last season?:

If yes, what was the name of the team?:

I will accept ages:

I would prefer ages:

I prefer to coach:

* Do you have children in the program?:

* If yes, what age group?:

Special Certification (i.e. CPR, Medical, etc):

* Have you ever been convicted of or plead guilty to any crime(s)?:

* If yes, describe each in full.:

* Have you ever been refused participation in any other youth programs?:

If yes, describe each in full.:

WAIVER INFORMATION

As a condition of volunteering, I give permission for the Spalding Basketball Association to conduct a background check on me, which may include a review of sex offender registries, child abuse and criminal history records. I understand that, if appointed, my position is conditional upon the league receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability the Spalding Basketball Association, the officers, employees, and volunteers thereof previous appointments. Spalding Basketball Association is not obligated to appoint me to a volunteer position, If appointed, I understand that, prior to the expiration of my term, I am subject to suspension by the President and removal by the Board of Directors for violation of the Spalding Basketball Association policies or principles.

I agree with the above *

NEW!!! Concussion Training is now required for ALL Spalding County Recreation Coaches. A copy of the NYSCA Certificate showing Concussion Training completion must be turned in with each coach's application!

NOTE: Spalding Basketball Association will not discriminate against any person on the basis of race, creed, color, national origin, marital status, gender, sexual orientation or disability.

I HAVE READ THIS FORM AND I UNDERSTAND THE FACTS PRESENTED IN IT. *

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Volunteer Coach Application