Become a Volunteer Coach Volunteer Coach Form Name * First Name Last Name Phone * (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Employment Phone * (###) ### #### Emergency Contact Name * First Name Last Name Emergency Contact Relationship * Emergency Contact Phone * (###) ### #### Physician Name * First Name Last Name Physician Phone * (###) ### #### Health Problems or Limitations * If none, please write "none" Educational/Special Training/Background in Work With Youth * What sport are you interested in coaching? * Certifications * Coaching License, Red Cross Training, etc. Have you completed Stratford Youth Sports Association Certification Workshop? * Yes No Please List Previous Volunteer Experiences * Have you ever been convicted of a crime? * Yes No If yes, please explain: Our Coach's Agreement I attest that the above information is correct. I authorize the investigation of all statements contained and understand that any false information is cause for termination of my volunteer role for any member organization of the Stratford Youth Sports Association (SYSA). I understand that the SYSA member organizations promote a drug free and smoke free sporting environment for youth. I understand: that the Sterling House youth basketball league is a recreational league that promotes fun, development, participation and sportsmanship; that official records and standings are not kept; that all team members must play at least one half of every game; that I must control my emotions as a positive example for my players, opponents, and spectators; and that I must respect the referees and supervisory staff who represent Sterling House, the Stratford Recreation Dept. and the Board of Education. I will do my best to supervise my players and remind them about respect for the school property they are allowed to use. Signature * First Name Last Name Today's Date * MM DD YYYY Thank you!
