Little League - Medicine Hat Form

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MEDICINE HAT LITTLE LEAGUE
2016 Regular Season Coaches Application
PERSONAL INFORMATION
Name: ______________________________________________
Age over 18? Yes _____
No _____
Address: _____________________________________________________ Postal Code: __________________
Phone Number: _____________________ Email Address : __________________________________________
DIVISION YOU WISH TO COACH
Little Sluggers (4 & 5)
Parent Pitch (6)
Machine Pitch (7)
Kid Pitch (8)
Kid Pitch (9)
Minors (10)
Majors (11 & 12)
Intermediates (12 & 13)
Juniors (13 - 15)
Head Coach
Assistant Coach
Either
Have you made arrangements to coach with another person?
Yes
No
If so, please provide the name of that person. _________________________________________________
Have you ever been convicted of a criminal offence?
Yes
No
Little League Canada has implemented a screening program for all Little League volunteers. I give my permission to Medicine Hat Little League to
conduct a background check on me which may include a review of sex offender registries, child abuse and police records. I understand, if appointed,
my position is conditional upon the league receiving satisfactory information on my background. I hereby release and agree to hold harmless from
liability, Medicine Hat Little League Association, Little League Canada, Little League International, the officers, employees and volunteers thereof, or
any other person or organization that may provide such information. I also understand, that regardless of previous appointments, Medicine Hat
Little League is not obligated to appoint me to a volunteer position. If appointed, I understand that prior to the expiration of my term, I am subject to
suspension by the President and removal by the Board of Directors for violation of Little League policies and principles.
Applicant Signature : ____________________________________________________________ Date : __________________________
Note - Medicine Hat Little League, Little League Canada and Little League Baseball Inc. will not discriminate against any person on the basis of race,
creed, colour, national origin, marital status, gender, sexual orientation or disability.

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