South Shore Longhorns

Longhorns Coach/Volunteer Application

PLEASE READ THE FOLLOWING COMMITMENT ATTACHED TO THIS APPLICATION. NO APPLICATION WILL BE ACCEPTED UNLESS THE COMMITMENT IS SIGNED.

* I HEREBY CERTIFY THAT I DO NOT USE DRUGS AND I DO NOT DRINK IN EXCESS. Initials::

* SPORT:

* POSITION REQUESTED:

* STATUS:

* SEASON:

* DIVISION:

* LAST NAME:

* FIRST NAME:

* MIDDLE NAME:

* EMAIL ADDRESS:

* STREET ADDRESS:

* CITY:

* STATE:

* ZIP:

CELL PHONE:

HOME PHONE:

* OCCUPATION:

* DATE OF BIRTH:

* SOCIAL SECURITY #:

* DRIVER'S LICENSE #:

* PREVIOUS EXPERIENCE:

* HAVE YOU EVER BEEN REMOVED FROM A POP WARNER OR OTHER YOUTH SPORTS EVENT, LEAGUE OR PROGRAM?:

* HAVE YOU EVER BEEN CHARGED AND/OR CONVICTED OF A CRIME?:

BY SUBMITTING THIS FORM, I HEREBY AGREE TO A HILLSBOROUGH COUNTY/POP WARNER BACKGROUND CHECK. I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND I ACKNOWLEDGE AND UNDERSTAND THAT IF THERE ARE ANY FALSIFIED STATEMENTS ON THIS APPLICATION THAT IT SHALL BE GROUNDS FOR DISMISSAL. I FURTHER UNDERSTAND THAT SHOULD ANY INFORMATION CONTAINED HEREIN CHANGE, I AM TO NOTIFY THE LEAGUE IMMEDIATELY.

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Longhorns Coach/Volunteer Application