Upward Basketball Coach & Referee Application 18/19

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone*

Cell Phone

Email*

Are you a regular attender of a local church?

Yes No

If yes, where?

Gender*

Date of Birth*

I would like to be a/an: *

Coach Referee Both

Select the age group you prefer to coach*

PreK - Kindergarten 1st and 2nd grade 3rd and 4th grade 5th and 6th grade 7th and 8th grade Any

What is your preferred practice day?*

Tuesday Thursday Either

What is your shirt size?*

Please list your children's name and grade who will be participating in this year's Upward league

Do you prefer to coach your child's team?

Yes No

Notes to Upward Staff

Have you ever coached Upward Basketball?*

Yes No

Have you made a personal commitment to Jesus Christ?*

Yes No

Please share a little about your relationship with Jesus Christ.

Will you attend the Coach's Training or the Referee Training Clinic:*

Coach Training - Monday, Nov. 26 @ 6:30pm at CBC Referee Training - Wednesday, Nov. 28 @ 6:30pm at CBC

Please select an evaluation date which you are available to volunteer.*

Tuesday, November 6 @ 5:30pm Thursday, November 8 @ 5:30pm Neither

I understand that any negative personal habits (smoking, alcohol, profanity, etc) may have a negative affect on a child's spiritual development. Understanding that the children on my team have been placed under my guidance, I commit to setting a worthy behavioral example for them to look to.*

I agree I do not agree

Today's Date*

Upward Basketball Coach & Referee Application 2018/19