LYAA Baseball & Softball

Coach Application

Required Concussion Training and Strongly Recommended Youth Protection Training for Coaches and Assitant Coaches. Links for these can be found at the bottom of the Welcome page. Please Check this box if you have completed this in the last year.

* First Name:

* Last Name:

* Address:

* City:

* State:

Phone (HOME):

Phone (WORK):

* Phone (CELL):

Date Of Birth:

* Email Address:

Employer:

Special Professional Training, Skill, and/or Hobbies:

Previous Volunteer Experience(Include sports and years):

Do you have a child playing in the Leeds Youth Baseball/Softball program?:

If you answered YES in the above question, please select childs age group.:

Please list any Special Certifications(CPR, Medical, etc):

Have you ever Been convicted of or plead guilty to any crime(s)?:

If you answered YES in the above question, please decribe each in full.:

Have you ever been refused participation in any other youth program? If YES please explain.:

Please read and sign:
I hereby certify that all statements made in this application are true. I acknowledge that any false statement or misrepresentation on this application will result in refusal of participation or instant dismissal of placement in the Leeds Youth Baseball/Softball coaching program. I understand that I am working , at all times, as a volunteer for the Leeds Youth Baseball/Softball Program and will not be compensated and not a paid employee. I agree that my position and participation with the Leeds Youth Baseball/Softball Program can be terminated at any time by the Leeds Youth Sports Baseball/Softball Board(LYSBSB). I give permission to the Leeds Youth Sports Baseball/Softball Board to conduct a background check on me which may include a review of sex offender registries, child abuse and criminal history records. I understand that, if appointed , my position is conditional upon the Leeds Youth Sports Baseball/Softball board receiving no inappropriate information on my background. I hereby release and agree to hold harmless form liability LYS, the officers, employees, and volunteers, including the members of the LYSBSB thereof, or any other person or organization that may provide such information. I also understand that regardless of previous appointments, that the LYSBSB is not obligated to appoint me to a volunteer position.

* Please Type Your Full Name(This is your electronic signature and is bound to statements above):

* Date of Apllication:

Signature:

Date:

* indicates required fields

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Coach Application