Crossfire Select Volunteer Coach Application

Please provide as much information as possible; attach references, resumes, required documents or other background information.

Personal Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Home Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Cell Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Employer {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Work Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Job Title/Occupation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Do you currently have a player in Rec or Select? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

If you have a player in Rec or Select, please provide the team name. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Special Notices

Subject to Disciplinary Action {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Terminated from Youth Organization {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

If Yes, please explain {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Desired Position

Please Choose {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Age Group {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Current or Past Coaching Experiences

Experience {binding ItemNumber}

Position {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Birth Year {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Starting {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Ending {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Club/Association/Sport {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Level of Play {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Noteable Items {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Coach Training Experiences

Cert/License/Clinic {binding ItemNumber}

Coach Licenses Acquired {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date Acquired {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

List 3 reasons you're applying to coach at Crossfire Select and why you want to coach a specific age group (if applicable). {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Describe your Soccer Playing and Training Experiences {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Additional Clinics, Seminars or Classes attended (with dates) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Resume {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Risk Management Clearance {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

References

Reference {binding ItemNumber}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Company {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

I have read the Coach's Agreement on the website and agree that, should I be accepted as a Head or Assistant Coach, for the duration of my affiliation with LWYSA, I will abide by WSYSA and LWYSA Codes of Conduct, existing policies and all applicable rules, regulations and laws.

I further understand that, if I accept a position as Head Coach, I am volunteering my time without compensation and it is my obligation to provide LWYSA with the names of all assistant coaches, trainers, team contacts, managers or anyone who will spend consistent time with the players relative to LWYSA and WSYSA soccer.

I understand that, should I be found in violation of any rules or policies of LWYSA and its affiliations, I will be given an opportunity for appeal as described in the WSYSA/LWYSA Coaches’ Handbook. If the violation is upheld, I will be subject to penalties specified, up to and including immediate suspension or dismissal. I further understand that some acts of misconduct may warrant immediate dismissal without an appeal.

I have read the Coach's Agreement and agree to the terms above. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

I understand that this is a volunteer position. Coaches with a player in the Club will have their fee waived {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}