Coaches, Assistant Coaches and Managers Application 2002-2003

First Name___________ Middle ____ Last ____________________
S.S. #_______________________
Address__________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Phone: Home __________________ Work __________________
email:___________________________________________________
Age group desired:
      Recreation: __ U5   __U6   __U7   __U8   __U10 __U12
       NCRSL:     __ U14 __U16 __U19
       Travel:        __U9 __U10  __U11 __U12 __U13__U14__U16__U17__U19
Gender desired (circle one) Male Female
Position desired? (circle one) Coach     Asst Coach   Manager
Do you have a coaches license ?_____ If so what level?__________________
In case of Emergency Doctors Name + Phone ________________________________
                                                                ________________________________

Signature____________________________

Make sure you also complete the Risk Management form.

Print and send to WYSA POB346 Westfield IN 46074 or bring to registration.