Columbia Dean Griner Dixie Youth Sports www.deangrinersports.org

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2022 Coaching Application Form

* Coach Name:

* Address:

* Home Phone Number:

* Mobile Number:

Date of Birth:

* Drivers License Number:

* Coaching Preference:

* League Participating In::

Any special requests or additional information you wish to share:

* Name of Child or Children Participating:

* Brief Summary of Coaching/Playing Experience:

* Have you ever been convicted of a felony or misdemeanor?:

* If yes, explain in detail:

By marking the "I Agree" box below you agree and certify that the above information is true and correct. You understand that the penalty for voluntarily certifying false information is the removal of all coaching privileges. You agree to abide by the rules and guidelines set by Columbia Dixie Youth Baseball Inc. and it's Board of Directors. You agree to conduct yourself in a manner that promotes sportsmanlike conduct. You also agree to be a role model for children both on and off the field. Finally, by marking the "I Agree" box below you give permission for Columbia Dixie Youth Baseball Inc. to conduct a background check on you.

I agree to the above *

* Name of Coach Agreeing to Above:

* Date:

* indicates required fields

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2022 Coaching Application Form