E-Soccer Coach Registration Form 2018

E-Soccer Logo

COACH INFORMATION

Gender (required)
MaleFemale

Shirt Size - Adult Sizes (required)
XSSML

I would like to be (required)
Head CoachAssistant/Jr Coach

PARENT or GUARDIAN INFORMATION (if coach is a minor)

EMERGENCY CONTACT INFORMATION (must be 18 or older)

QUESTIONNAIRE

Has the volunteer worked with children, including children with special needs in other sports programs? (required)
YesNo

As part of the application process, do you agree to allow the E-Soccer Program to conduct a criminal records check to help determine the applicant's suitability to work with children in the position the volunteer is applying for?
YesNo

Does the volunteer applicant have any special needs that the E-Soccer program should be aware of in regard to participation in the Program?
YesNo

Has the volunteer ever been diagnosed by a medical doctor with allergies, asthma, hemophilia, heart condition history of respiratory illness, or other significant medical condition?
YesNo

If applicant is a minor, is this going towards 'service learning hours'?
YesNo

Does the applicant agree to commit to 2 hours every Saturday from 3:30 - 5:30pm beginning March 24 - April 28?
YesNo

Does the applicant agree to attend the workshop training on March 17, 2017 from 9am-12pm?
YesNo

By checking this box, I acknowledge that I have read and understood the Release of Liability and give full consent.