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Edgewater Park Athletic Association
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Volunteer Coach Registration
COACH INFORMATION
*
Coach First Name:
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Coach Last Name:
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Address:
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City:
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House Phone Number:
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Mobile Phone Number:
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Email (used to send confirmation):
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What Year Did You Start Coaching For The EPAA?:
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What Year Did You Complete Rutgers Certification?:
IF YOU HAVE NOT YET COMPLETED RUTGERS CERTIFICATION, ENTER: TBC
Choose The Sport/s You Wish To Coach
T-Ball
Baseball
Softball
Flag Football
Cheerleading
Soccer
Basketball
Township Ordinance Applies (Background Check)
You are at least 18 years old or older
*
Fingerprint Form
It is an Edgewater Park Ordinance that all board members, commissioners and coaches have their fingerprints taken and submitted to the Edgewater Park Police Department for a background check. The form with all information is attached. Please enter this website into your internet browser, www.bioapplicant.com/nj to schedule an appointment. The company is MorphoTrak and is the only company that we accept. The cost of the fingerprints are $26 and will be re-imbursed by the EPAA once we receive the completed receipt. This will need to be completed on a 3 year basis. Be advised that you will not be allowed to coach without having taken and passed the background investigation! No exceptions!
For more information on the background check go to the state site - http://www.state.nj.us/njsp/about/serv_chrc.html#vcp
You can download the form from the main page of the EPAA website or from under the "Coaches Corner" tab in the menu on the left side of the EPAA website.
You will need to put C08003 in box #7, and you will need this number to schedule your appointment.
I Will/Have scheduled an appointment
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Date if appointment is scheduled:
Jan
Feb
Mar
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May
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Oct
Nov
Dec
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2016
• EACH FAMILY AGREES TO ABIDE BY THE EPAA’S CODE OF CONDUCT POLICY.
• FAMILIES ARE EXPECTED TO PARTICIPATE IN FUNDRAISING TO KEEP OUR EXISTING REGISTRATION FEES.
• EACH FAMILY IS RESPONSIBLE FOR WORKING THE CONCESSION STAND AT LEAST ONE GAME DURING THE SEASON.
MEDICAL/EMERGENCY INFORMATION
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Emergency Contact:
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Phone:
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Indicate specific medical allergies, chronic illnesses, or other medical conditions that coaches and medical personnel should be aware of: (Physician Release to Play Required for any ailments listed):
Check below if interested in helping with other EPAA activities:
Fundraising
Sponsorship / Sponsoring
Donations
Concessions
Volunteering
I hereby give approval for the participation of myself in any and all affiliated associations or league activities and I assume all risk and hazards incident to such participation including transportation to and from said activities. I waive, release, absolve, indemnify, and agree to hold harmless the EPAA and affiliated associations, leagues, the organizers, supervisors, officers, directors, board members, participants, and persons or parents supervising or transporting participants to or from such activities, from any claims arising out of injury to myself. I understand that a player/coach who registers with a league is bound to that league for the entire seasonal year unless a transfer is approved for extenuating circumstances. My family agrees to abide by the EPAA’s Code of Conduct Policy.
I hereby authorize the treatment by a qualified and licensed medical doctor in the event of a medical emergency which, in the opinion of the attending physician, may endanger my life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach my emergency contact. I hereby grant this release for the season in which i am coaching.
This registration and medical release form is completed and signed of my own free will for the sole purpose of authorizing participation in the league and authorizing medical treatment under emergency circumstances in my absence:
WAIVER INFORMATION
I/we agree with the above
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Other Notes to EPAA::
* indicates required fields
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