RCSA Volunteer Coaches Application

Full Name:

Physical Address:

Mailing Address

City

Postal / Zip code

Home Phone:

Work Phone:

Cell phone:

Emergency Contact:

Phone:

Are you 18 years or older?

Yes

If under 18, list your age:

Parent or Guardian (if minor):

Do you have a driver’s license?

Yes

Have you had First Aid, CPR or AED training?

Yes

Please state what date it expires

1. List your personal sports and recreation experience:

2. List your previous coaching experience:

3. List your previous leadership experience:

4. Describe your previous work with children:

5. Please list other skills, which qualify you as a youth coach:

6. Are you interested in the National Youth Sports Coaches Association program, which provides training for “How to Coach”, coaching your specific sport, first aid, and provides personal liability in insurance?

Yes

Would you be willing to invest up to two- (2) hours video training hours and $20 in this program?

Yes

7. Please prioritize the age groups you would prefer to work with (1 = highest priority, 6 = lowest). If you would prefer NOT to work with an age group, please note that.

Ages 5 & 6

Yes

Ages 7 & 8

Yes

Ages 9 & 10

Yes

Ages 11 to 14

Yes

8. Please list three references that will attest to your qualifications as a youth coach:

I affirm the information I have provided is true and accurate, to the best of my knowledge. If contracted or hired as a volunteer, I agree to uphold the rules, regulations, mission and sportsmanship guidelines as presented by Refugees Community Services Association. I further agree to participate with the known risk of injury inherent in sports. I agree to release my name and photo likeness in relation to this specific program for promotional items or news releases to benefit the association or youth leagues, sports, or clinics.

Signature Date

Parent or guardian, if under 18

RCSA Volunteer Coaches Application

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