Coach'S Information Form

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Lynchburg Parks & Recreation
Coach’s Information Form
Name: _________________________________
Team: ______________________________
Cell Phone: ______________ Home Phone: ________________ Work Phone: ________________
Address: ________________________________ City: __________________ Zip Code: __________
E-Mail: ________________________________________
Desired level of coaching:
:
9-10
11-12
13-14
15-18
Boys
:
9-10
11-12
13-14
15-18
Girls
Experience as a coach:
Have you ever coached youth basketball for Lynchburg Parks & Rec?
Yes
No
If so, what age? _________ How many seasons? __________ Team Name: ____________
Please check one:
Head Coach ___
Assistant Coach ___
List other youth sports you have coached: _________________________________________
____________________________________________________________________________
How many years? __________
Are you ASEP Certified? _________________
_______________________________________
______________________
Signature
Date
Office use only:
___ Criminal Background Release Form
___ Volunteer Coaching Form
___ ASEP Youth Basketball Coaching Certification - date completed: _______________
___ Coach’s Code of Ethics
___ Team Assignment: _________________________________
___ Age Group: ______________

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