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Coach / Team Mom Application
League Rules requires all Volunteers to be approved in advance prior to entering into the dugouts. Please fill out the following application if you are interested in coaching or volunteering for Team Mom.
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First Name:
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Last Name:
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Street:
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City:
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Zip Code:
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EMail:
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DOB::
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NCDL#:
SSN:
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Occupation:
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Home Phone:
Work Phone:
Cell Phone:
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Emergency Contact:
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Phone:
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What volunteer Position are you interested in:
Head Coach
Assistant Coach
Team Mom
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Will you have a child in the program?:
Yes
No
Name of Son/Daughter:
Age Of Child:
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Indicate which divisions you would be interested in coaching/Team Mom::
T-Ball
Softball 6U
Softball 8U
Softball 10U
Softball 12U
Softball 14U
Softball 16U
Baseball 8U
Baseball 10U
Baseball 12U
Baseball 15U
If you have a specific Team you would like to be associated with, please list below::
*
Have you ever been trained or certified as a youth coach?:
Yes
No
Coaching Experience (specify sport, age group, when, where, and how long you participated).:
Special Information (information about additional help you can provide: equipment, work experience that may be useful to the organization, positions for which you might volunteer for and if you have more than one coaching or volunteer position):
References: List name and phone number of two personal references other than family:
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Name:
*
Phone:
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Address:
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Name:
*
Phone:
*
Address:
I certify that all statements made on this application are true and complete and understand that any deliberate misstatement or omission will cause forfeiture of all eligibility to volunteer with the Chocowinity Recreation Department. I also hereby give my permission for the Chocowinity Recreation Department to conduct a criminal history check and I do hereby release all parties and individuals connected therewith from all liabilities for any damages whatsoever incurred in furnishing such information. By entering your full name below, you electronically acknowledge reading and understand the above.
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Signature (Type full name to electronically sign):
*
Date:
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* indicates required fields
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