Coaches Application

UpdatedTuesday January 21, 2020 bySK.

SGSA COACHES APPLICATION

2020

FULL NAME (FIRST, MIDDLE, LAST): ____________________________________________________________

PREVIOUS NAME, MAIDEN, OR NICKNAME:_____________________________________________________

DATE OF NAME CHANGE OR MARRIGE DATE: _____/______/______

MAILING ADDRESS:__________________________________________________________________________  

HOME PHONE :(_________)__________________________            

CELL PHONE: (_________)___________________________  

DATE OF BIRTH:  ______/______/_________           GENDER: ___________________________________

SOCIAL SECURITY NUMBER: ________________________________

DRIVER’S LICENSE NUMBER: ______________________________________    STATE: __________________

EMAIL ADDRESS: ____________________________________________________________________________

Have you ever been convicted of a crime?   YES / NO (circle one)  

If YES, please explain ____________________________________________________________________________

Are you Rutgers Safety Certified or Babe Ruth Certified?     YES / NO

** Please provide a copy of your certification to the board

 

Did you coach softball in SGSA last season?   YES / NO

The team Sponsor & Division you coached for last season________________________________  

Shirt size:             Small           Medium             Large               X-Large             XX-Large

All persons completing this form must read and sign below:  I consent to have the Stafford Girls Softball Association use this information above to conduct a background check to determine whether an allegation of child abuse or a criminal allegation has been substantiated against me.  I certify that all information I have given on this form is accurate and complete to the best of my knowledge.

Signature: ________________________________________________ Date: _______________________________

Note: Pursuant to federal Privacy Act of 1974 (P.L. 93-579), the disclosure of your Social Security number is voluntary.  Your Social Security number, race, date of birth, and gender will only be used for the purpose of conducting a Child Abuse Record Information background check as authorized by the State Child Care Center Licensing Law (N.J.S.A. 30:5B-1 to 15)

 

*A COACHES APPLICATION AND VOLUNTEER APPLICATION MUST BE SUBMITTED TO THE BOARD 

2020 Coaching Application.pdf