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Coaching Application
Filling out this form implies your intent to coach basketball with Ankeny Basketball Club.
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Email
*
Your email
Basic Applicant Information
Applicatant's First Name
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Your answer
Applicant's Last Name
*
Your answer
Applicant's Cell Number
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Your answer
Applicant's Gender
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Female
Male
Other:
Applicant's Birthdate
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Applicant's Email Address
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Your answer
Applicant's Address
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Your answer
Applicant's City, State Zip
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Your answer
Applicant's Past Address/Addresses (if different, over the past 5 years)
*
Your answer
Do you have a player in the program?
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Yes
No
If YES, fill in Child's name and grade in 2019-2020 school year
Your answer
Position Desired
Head Coach
Assistant Coach
Other:
Clear selection
Information Required for the Background Check
Do you have a Driver's License
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Yes
No
State that issued your driver's license?
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Your answer
Applicant's Driver's License Number
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Your answer
Have you ever been convicted of a crime?
*
Yes
No
If Yes, pleases provide details
Your answer
Experience
Have your ever been removed from a youth sports event, either as a coach or a spectator?
Yes
No
Clear selection
Describe your experience as a player in this sport?
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Your answer
How many years have your played this sport?
Your answer
Describe your experience working with youth?
Your answer
How many years have you worked with youth?
Your answer
Describe your experience working with youth in this sport?
Your answer
How many years have your worked with youth in this sport?
Your answer
Notes/Questions
Your answer
Waiver of Liability
Waiver of Liability
I hereby grant approval for myself to participate as a Coach for a basketball teams organized by the Ankeny Basketball Club. I further waive any cause of action I might have against the Ankeny Basketball Club for injuries which I might sustain as a result of said participation and coachng.
Photography Release
I hereby grant approval for photographs or likenesses of myself be released without written consent unless the parent/guardian provides the Ankeny Basketball Club with written notification that they object to this policy. This written notification must be submitted to the Board of the Ankeny Basketball Club.
Application Submission
NOTICE: Any falsified answer may result in immediately removal from the application process.
I, the undersigned, have read, understand and truthfully answered the questions above and accept the information. Therefore, I submit my application for a position with Ankeny Basketball Club.
Your answer
Type your name on the line above as your signature
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A copy of your responses will be emailed to the address you provided.
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