E-Soccer Coach Registration Form 2018 COACH INFORMATION Last Name (required) First Name (required) Gender (required) MaleFemale Age (required) 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) Name Volunteer/Parent/Guardian Phone (required) Alt Phone (required) Volunteer/Parent/Guardian Email (required) EMERGENCY CONTACT INFORMATION (must be 18 or older) Name (required) Relation (required) Phone (required) QUESTIONNAIRE Has the volunteer worked with children, including children with special needs in other sports programs? (required) YesNo If yes, describe 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 yes, describe 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.