Milwaukie Youth Basketball Association

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Coaches Application

* First Name:

* Middle Name:

* Last Name:

* Address:

* City, State, Zip:

* Gender:

* DATE OF BIRTH:

* Home Phone:

* Auto Insurnace Provider:

* Work Phone:

* Email:

* Grade Level Requestion to Coach:

* Coaching Position:

Would like to Coach with: (one name only):

Coaching Experience:

Coaching References:

Breifly Explain Your Philosophy as it to Winning:

Briefly Explain Your Philosopy as it Applies to Sportsmanship:

Briefly Explain Your Philosopy as it Applies ot Discipline:

What is your personal athletic participation background?:

What is your basic coaching philosophy?:

* Do you have a valid first aid card?:

AUTHORIZATION

I the undersigned, authorize this information to be obtained in connection with my volunteer application. Any person, firm or organization providing information or records in accordance with this authorization is released form any and all claims of liability for compliance. Such information will be held in confidence in accordance with the organization’s guidelines.

I authorize MMYBA to run a background check. *

* indicates required fields

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Coaches Application