COACH/VOLUNTEER/INTERNSHIP APPLICATION
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are required.
First Name:
*
Middle Name:
Last Name:
*
Email Address:
*
Confirm Email Address:
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Cell Phone Number:
*
Secondary Phone Number:
*
Employer / School:
*
Date of Birth:
*
Address 1:
*
Address 2:
City:
*
State:
*
ZIP Code:
*
Are you interested in becoming a Summer Youth Coach, a Program Volunteer and/or an Intern?
Summer Youth Coach
Program Volunteer
Intern
T-Shirt size:
XS
S
M
L
XL
XXL
Please list any special skills, certifications, or qualifications that you possess (i.e. CPR certification, experience working with special needs youth, coaching trainings, finance/accounting/bookkeeping skills, marketing/PR background):
Please list any additional languages that you speak fluently:
Have you played soccer before?
yes
no
If yes, what is total number of years you have played soccer?
Have you ever played soccer competitively?
yes
no
If yes, please list your highest level of playing experience:
Have you ever taught or coached any sport before?
yes
no
Have you ever taught or coached youth soccer before?
yes
no
If you have coached, please list the timeframes and locations where you coached:
Do you currently have health insurance?
yes
no
Contact in case of emergency (name and phone number):
List previous injuries:
List any current medical conditions:
List allergies (including any medication allergies):
Subscribe to Pickup Soccer YOUTH OUTREACH newsletter
Yes