Coach Application

Indian Creek Chiefs Youth Football Association, INC
Head Coach / Assistant Coach Application
(All information provided is kept confidential)
Personal Information (Please print all information)
Football Coach Information
Coaching Back Ground
I UNDERSTAND THAT:
A: The information that I have provided may be verified, if necessary , by obtaining a record check and/or contacting persons or organizations that may have information concerning me. I hereby release and agree to hold harmless any person or organization that provided the information. I also agree to hold harmless The Indian Creek Chiefs Youth Football Association, officers, volunteers, and any other person or organization that provided information.
B: In signing this application, I affirm that the information I have given is true and correct.
Signature:____________________________________ Date:____________
Please mail application along with “Concussions in Sports—What you need to know” completion certificate to:

Indian Creek Chiefs Football
c/o Christopher Parks
1881 State Route 151.
Mingo Junction, OH 43938
BOARD USE ONLY
Approved ( ) Disapproved ( ) DATE: ______________________________
Team Assigned: BANTAM JV VARISTY
NOTES:
The Indian Creek Chiefs Youth Football Association does not limit participation in its activities on the basis of disability, race, color, national origin, gender or religious preference.
 

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