Coaches Agreement

* Indicates required field

Name *

First

Last

Home or Cell Phone Number *

Street *

City, St., Zip *

Date of Birth *

As a volunteer working with children, ALL coaches must be Safeguarding Certified. This involves a one time class and a background check every five years.

Access the Archdiocesan Safeguarding site to sign up for the class and authorize your initial background check HERE.

When our records show a 5 year check is necessary, you will be contacted for the information by your sport coordinator.

Coaching Experience:

Volleyball? *

Yes

Basketball? *

Yes

Track? *

Yes

Other, please describe: *

Volleyball Coaching Dates: *

Basketball Coaching Dates: *

Track Coaching Dates: *

Other Coaching Dates: *

Are you certified as a coach or referee in any other sport? *

If Yes, What and When? *

Have you undertaken a "coaching" seminar or course? *

If Yes, Where and When? *

Do you maintain a valid Wisc. Driver's License? *

License #: *

Have you incurred any citations in the past three years? *

If yes, what & when? *

Are you First-aid CPR/AED certified? *

Have you ever been convicted of, plead guilty to, or nolo contendere to an offense (including felony, misdemeanor or municipal ordinance) or are you now subject to a pending criminal charge? *

If yes, describe in detail. *

I wish to participate in the sport(s) identified above as a coach or coaches' assistant . I have reviewed the Archdiocesan rules and regulations for the previously mentioned sport(s) and agree to abide by them.

I certify that the information provided by me above is true and complete to the best of my knowledge. I understand that if I am accepted as a coach, any false statements or omissions may lead to termination of my duties, and I agree that the parish/school shall not be held liable in any respect if my volunteer assignment is terminated for this reason.

I authorize the parish/school to verify the information stated above by means of a criminal records check. I agree to follow the policies of the Archdiocese and the parish/school, and I pledge to join with the church in its efforts to provide a safe and secure environment for our children and youth.

I have read, understand, and agree to the above statement. *

Yes No

Date (mm/dd/yyyy) *

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