Your Name:             

Your Email Address:

Position for which you are applying (i.e. head coach 4th grade, assistant on which coach's staff, etc):

Grade:	Pick MM 3rd 4th 5th 6th 7th	Position for which you are applying. Select One Head Coach Assistant Coach Name of Head Coach if known and other than you.

Date of Birth ( month / day / year ):   

Address:           

City:                  

Zip Code:           

Home Phone:     

Work Phone:      

Name(s), Age(s), & Activity Of Children in SYFA:   

Have you been convicted of any felony within the last ten years?:    Select Yes No

If yes, please state for each said conviction, date of conviction, the offence of which you were convicted and the court in which you were convicted:

Please state in detail your prior experience that would benefit and assist you in performing your duties and activities for which this application is made:

By submitting this information you certify that the facts contained in this application are true and complete to the best of your knowledge and understand that, if approved, falsified statements will be grounds for dismissal. You authorize investigation of all statements contained her-in and all information concerning previous coaching assignments and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

The position of head coach or assistant coach, is an appointed position upon the approval of the board of directors of the Stillwater Youth Football Association, INC. and any person approved and designated as such will hold that position for no definite period of time and may, regardless of the date of approval of position, be terminated at any time without prior notice for whatever reason(s) the board of directors deems necessary.