Name

First Name

Last Name

Street Address

City

Postal Code

Email Address

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Certification

NCCP Level Completed

NCCP Certification Number

Modules Completed

Making Ethical Decisions

Making Headway in Football

Safe Contact

Respect in Sport Number

Coaching Position

Coaching position you are applying for? Select one of the following. If you are willing to be either Head Coach or Assistant Coach, then check both.

Head Coach

Assistant Coach

Equipment Manager

Trainer

Team Manager

Other (Please Specify)

Other Description

Teams

What team are you applying for? Select one of the following

Crunchers (8 & 9 years)

Atom (10 & 11 years)

Peewee (12 & 13 years)

Bantam (14 & 15 years)

Midget (16 to 18 years)

Major (18 to 23 years)

Junior Girls (10 to 13 years)

Senior Girls (14 to 17 years)

Coaching or volunteer experience

List any other coaching or volunteer experience in youth sports of any kind

Other qualifications

What qualities or characteristics do you bring to the position of Head/Assistant coach or other member of the coaching staff?

Head Coach preference

Is there a particular head coach that you would like to coach with? Please note that this does not guarantee that you will be placed on this Head Coach's staff.

Clinics attended or other certifications

List the names of any football instructional clinics you have attended and cerificates you hold for coaching, trainer or equipment manager.

Children playing football

List any children you have who play for the Mustangs and their age group

Convicted of an offense

Have you ever been convicted of an offence under the Criminal Code of Canada or any Federal or State Penal Code in the United States of America?

Yes

Convictions details

If you answered yes to above, please explain

Refused participation in youth sports

Have you ever been refused participation in any youth sports program?

Yes

Refusal details

If you answered yes to above, please explain

Agreement of Applicant

By submitting this application, you affirm that the facts set forth in it are true and complete. You understand that if you are accepted as a Head coach or member of the coaching staff, any false statements, omissions, or other misrepresentations made by you on this application may result in my immediate termination. You further authorize an investigation of your background including criminal activity, personal or otherwise, and release all parties from all liability for any damage that may result from obtaining such information. You understand that your position on the coaching staff may be terminated at any time without prior notice for whatever reasons the Board of Directors of the St. Vital Mustangs deems necessary.

Thank you for your submission.

St Vital Mustangs Coaches Application