HYL Dixie Softball - Registrations

Register to be a Coach

First Name

Last Name

Street Address

City

State

Zip

Telephone Number - -

Previous states resided in the past 5 years

Date of Birth

Social Security Number - -

Occupation

Employer

Employer's Address

Do you Have Valid Drivers License?

Driver License Number

Driver License Issued State

In which of the following would you like to participate(check one or more):

League Official

Head Coach

Board Member

Equipment Manager

Assistant Coach

Team Mom

Coach Trainee

Trainer

Student Demo

Special professional training, skills, hobbies

Community affiliations (Clubs, Service Organizations, etc.)

Previous/current volunteer experience (e.g. baseball/softball and years)

Do you have children in the program?

If yes, at what level?

Special Certification (i.e. CPR, Medical, etc.)

Have you ever been convicted of a felony?

If yes, please provide legal status (parole, etc)

Have you ever been convicted of ANY crime involving or against a minor?

If yes, please explain

Have you ever plead guilty to or been convicted of or involved with any other type of crime?

If yes, please explain

Have you ever been refused participation in any other youth programs?

If yes, please explain

Signature

I declare under penalties of perjury, this report and/or payment (including any accompanying schedules) has been examined by me, and to the best of my knowledge is a trie, correct and complete report.

Register to be a Coach

National Dixie Site