Youth Sports Coaching Application

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Coaching Application

Please correct the field(s) marked in red below:

Personal Contact Information

 First Name
 *
Last Name
 *
Primary Phone Number
 *
Alternate Phone Number
Email Address
 *

Street Address

 *
City
 *
State
 *
Zip Code
 *
What is your occupation?
 *
What is the name of your employer?

Emergency Contact Information

First Name
 *
Last Name
 *
Phone Number
 *
Email Address
 *

Select the sport / age division(s) you wish to coach.

We do allow coaches to coach more than one team.  If you want to coach more than one team this season, be sure to select the correct sport / age divisions from the lists below.

Team 1: Sport / Age Division
 *
Team 2: Sport / Age Division (If applicable)
Team 3: Sport / Age Division (If applicable)

Please select the closest Peoria Unified School District elementary school to your residence.
 *
Please select your Practice Day Preferences in order of importance.
First Choice
 *
Second Choice
Third Choice
What size coaching shirt will you need?
 *

Please provide the NAME of the FAMILY MEMBER that should be placed onto your team.

Note:  You are not registering this person, you are only providing the name of the individual.  This person will need to register for our league separately from this coaching application.

Are you 18 years of age or older?
 *
Are you 18 years of age or older?
Have you coached a City of Peoria youth sports team before?
 *
Have you coached a City of Peoria youth sports team before?
Please list any other youth sports coaching experience you have with voluntary organizations.

Background Check Disclaimer 

The City of Peoria conducts a background investigation of criminal history.  A criminal conviction does not constitute an automatic bar to employment (volunteerism).  Each case is considered individually and based on job requirements.  However, failure to answer truthfully may result in disqualification or termination of employment (volunteer opportunity) with the City.

Have you ever been convicted of any violations (including traffic) of Federal, State, Local or Military laws or statutes?
 *
Have you ever been convicted of any violations (including traffic) of Federal, State, Local or Military laws or statutes?
If you have been convicted, please provide the date(s) and conviction(s).

Code of Ethics Acknowledgement.
 *

By typing my initials, I certify that all information on this form is true to the best of my knowledge.  I also authorize the City of Peoria Community Services Department to make all necessary and appropriate investigations allowable by law.  It is my responsibility to keep the Community Services Department advised of any changes in address or phone numbers.

Initial in the box below

 *
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