VISITATION B.V.M. PARISH
APPLICATION TO COACH
CYO PARISH ATHLETIC PROGRAM

NAME ___________________________________   PHONE (Home) _______________________
       PHONE (Work) _______________________

ADDESSS __________________________________________________________________
CITY ___________________________________ STATE __________ ZIP _______________

OCCUPATION ________________________________________________________
SPORT __________________________________ GRADE DESIRED _____________________

NAMES & AGES OF CHILDREN ______________________________ GRADE ______________
    _______________________________ GRADE ______________
    _______________________________ GRADE ______________
    _______________________________ GRADE ______________
If more than 4 children -others _____________________________ GRADE ______________

ARE YOU HIGH SCHOOL AGE (9th GRADE) OR OLDER? ___________

COACHING EXPERIENCE

Have you coached Catholic Youth Sports before?  ______ If yes, list sports, dates, grades, and parishes:

______________________________________________________________________________

Have you coached other youth sports before? _______ If yes, list sports, dates, grades, and organizations:

______________________________________________________________________________

Have you worked with youth previously in programs other than sports? ____ If yes, list below:

______________________________________________________________________________

Are you active in any other parish organizations (List)? ____________________________________________________________________________________________________________________________________________________________

Are you certified in Red Cross first aid? _________ CPR ____________________

ADDITIONAL QUESTIONS

Why do you want to coach? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
How do you see your role of a coach as a minister to youth?
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What goals do you have for the coming season?
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What are the areas that you have a need for training?
_________________________________________________________________________________________________________________________________________________________________________________________________________
Have you ever been disciplined or removed by another parish program, or by any other youth-serving organization? _________ If yes, please provide details:
______________________________________________________________________________________________________________________________________
I certify that the above answers are accurate and true to the best of my knowledge.  I will agree to abide by the parish and league rules, The Code of Conduct, and the direction of officials as a volunteer coach.  I understand that to coach, I must be accepted by the parish organization and complete Diocesan Coaches Certification requirements by attendance annually at a Coaches Certification Workshop for the sport I wish to coach.
Date: __________________   Signature _________________________________

Interviewed by: _______________________________________ Date _____________________

Accepted ______________________ Grade / Sport Assigned ____________________________

Rejected _______________________

Signed ___________________________________________ Athletic