Date of Birth

Name

Address

City

State ZIP

Alabama Alaska Arizona Arkansas California Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Main Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania RhodeIsland South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming    

Phone (Day)

Email, FAX

Previous
Coaching
Experience

SKYBALL Area

Requested Team

Grade 6th Grade 7th Grade 8th Grade     Boys or Girls Boys Girls No Preference     Skill Level Recreational Developmental Competitive No Preference

Do you have a
child in SKYBALL?

No Yes     Select 6th Grade 7th Grade 8th Grade     Select Boy Girl

Have you ever been
convicted of a crime?

No Yes   If Yes, explain...

Have you ever
participated in a court
diversion program relating
to anger management
or child or sexual abuse?

No Yes   If Yes, explain...

Have you been
convicted of any alcohol related offenses of any
kind in the last three years?

No Yes   If Yes, explain...

Please Provide
Two References

Name, address and phone     Name, address and phone

Coach's
Code of Honor

I promise upon my word of honor to help create an environment in which primary emphasis is placed upon the emotional and physical well being of all SKYBALL athletes rather than winning. I will lead by example and will demonstrate the value of fair play and sportsmanship to all participants. I agree to be bound by all of the game and operational rules of the SKYBALL program as well as the SKYBALL policies and goals.

I affirm that I have responded to all questions in this Registration form truthfully. I understand that failure to respond accurately, completely, and truthfully will result in my not being considered for a coaching assignment, and/or that any coaching assignment previously awarded will be forfeited. I authorize SKYBALL to obtain court and criminal records to verify the information contained in this coaching application.

I Agree

Please Select I Agree