APPLICATION TO COACH IN THE PITT MEADOWS SOCCER CLUB


(* denotes required fields. All others are optional.)

* Name:
*Street Address:
*Birthdate (d/m/y) :
*City:
*Postal Code :
*Res. Telephone :
*Bus. Telephone :
*Email Address :
   
  * I wish to be considered to coach the following age level/gender(s). Please select only one age group.
               
  Mini-Soccer: Boys Girls Mixed      
  Age Group: Under-5 Under-6 Under-7 Under-8 Under-9 Under-10
               
  Boys Under-11:          
  Girls Under-11:   Select House    
  Boys Under-12:          
  Girls Under-12:          
               
  Boys Competitive: Gold Silver Bronze House/Red    
  Girls Competitive : Gold Silver A Silver B      
  Age Group: Under-13 Under-14 Under-15 Under-16 Under-17 Under-18
               
  I have completed the following BCSA/National Coaching Certification Program Courses:
    Community-Youth Community-Senior B-prep
 B Provincial B National
  
  Other?
( Please list)
     
  If you do not have any coaching qualifications, are you prepared to take part in the next available course?
    Yes No        
  If no, please state reasons:
     
  I have coached at the youth soccer level for years and/or at the senior soccer level for years!
  Team last coached?
  Age group: Under-
  District:
  Season: (e.g. 2006/2007)
     
  * Please provide a brief statement on your philosophical approach to coaching children in sport and/or the reasons for your wishing to be involved in coaching children (if you wish to provide more, please attach to application):
 
     
  If you are applying to coach in the Club for the first time, please provide the names of at least two people who will be willing to provide references as to your suitability to coach in youth soccer and your general character.
     
  Name: Relationship: Phone:
  Name: Relationship: Phone:
     
  Are you prepared to coach the team you are applying for if your child is not selected to this team? (To be completed by coaches applying for a “competitive” age-group team only)
    Yes No        
     
 

* I, agree that should I be assigned to coach a team in the Pitt Meadows Soccer Club, I will abide by the Constitution, Bylaws, Policies and Procedures and general philosophy of the Club.

I further grant permission for the Pitt Meadows Soccer Club to conduct a criminal record check with the R.C.M.P. in regard to any possible record pertaining to any charge relating to misconduct involving children.