Fillable Coach Application Form - Cambridge Youth Soccer (Page 2 of 2) in pdf

CYS will reimburse the entire course fee to any active coach who satisfactorily completes a license

course. Courses range from a 4-hour G license to a 40-hour D license course. Reimbursement for

national level licenses beyond D requires a special application.

Are you interested in taking a license course? Yes

Which level? ______________

OTHER PERTINENT INFORMATION: Coaching philosophy, playing experience or anything that

you wish to add: ________________________________________________________________

I have a copy of the CYS Coach’s manual

Please send me a CYS Coach’s manual

Coach & Assistant Coach Applicants Only:

BY SIGNING THIS FORM APPLICANT REPRESENTS THAT ALL OF THE INFORMATION PROVIDED HEREIN IS

TRUE AND THAT HE OR SHE HAS READ CYS COACH’S GUIDELINES FOR SAFETY.

Print name: ____________________________ Signature: _______________________________

Date: ____________

Coach and Assistant Coach applicants must also sign the consent and release below.

REFEREES:

In-Town

Travel (BAYS)

Referee License Level: ___________

Please attach copies of your current USSF certification and ID card

Referee Experience: ______________________________________________________________

ALL VOLUNTEERS MUST SIGN THE APPROPRIATE CONSENT AND RELEASE!

MINOR – A parent or legal guardian must complete this

ADULT – This section must be completed when

section for an applicant under the age of 18.

an applicant has attained legal majority.

CONSENT FOR MEDICAL TREATMENT (MINOR):

CONSENT FOR MEDICAL TREATMENT:

As Parent or legal guardian of the above named player, I

I hereby give my consent for emergency medical

hereby give my consent for emergency medical care

care prescribed by a duly licensed Doctor of

prescribed by a duly licensed Doctor of Medicine or Doctor

Medicine or Doctor of Dentistry. This care may be

of Dentistry. This care may be given under whatever

given under whatever conditions are necessary to

conditions are necessary to preserve life, limb, or well-

preserve life, limb, or well-being.

being of my dependent.

RELEASE:

I agree that I will abide by the rules of USYSA,

I, the parent/guardian of the registrant, a minor, agree that

MYSA, BAYS, CYS, affiliated organizations and

the registrant and I will abide by the rules of USYSA,

sponsors. Recognizing the possibility of physical

MYSA, BAYS, CYS, affiliated organizations and sponsors.

injury associated with soccer and in consideration for

Recognizing the possibility of physical injury associated

the USYSA, MYSA, BAYS, CYS accepting my

with soccer and in consideration for the USYSA, MYSA,

registration for the soccer programs and activities

BAYS, CYS accepting the registrant for its soccer

(the “Programs”), I hereby release, discharge and/or

programs and activities (the “Programs”), I hereby release,

otherwise indemnify the USYSA, MYSA, BAYS, CYS,

discharge and/or otherwise indemnify the USYSA, MYSA,

affiliated organizations and sponsors, their

BAYS, CYS, affiliated organizations and sponsors, their

employees, volunteers and associated personnel,

employees, volunteers and facilities utilized for the

including the owners of fields and facilities utilized for

Programs, against any claim by or on the behalf of the

the Programs, against any claim by or on my behalf

registrant as a result of the registrant’s participation in the

as a result of my participation in the Programs and/or

Programs and/or being transported to or from the same,

being transported to or from the same, which

which transportation I hereby authorize.

transportation I hereby authorize.

Participant name: _______________________________

Name: ___________________________________

Parent name: __________________________________

Signature: ________________________________

Parent signature: _______________________________

Date: ____________________________________

Date: _________________________________________

Coach Application Form - Cambridge Youth Soccer Page 2

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