Part-Time: Head Coach / Junior Assistant / Referee
Application Form
Westkhoops Programs
Name
*
First Name
Last Name
Please provide your Birthdate:
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-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please indicate which Program (s) you are most interested in Coaching & Assisting?
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Please Select the Part-Time Position you are most interested in Coaching, Reffing, or Assisting:
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Camp Coach
Volunteer Coach
High Performance Coach
Camp Youth Assistant
Camp Volunteer
Club League Youth Assistant
Club League Volunteer Coach
Referee
Scorekeeper
Please Select grade or age group you are interested in Coaching or Assisting
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Grade 4 & 5 (Ages 10 & 11)
Grade 6 & 7 (Ages 12 & 13)
Grade 8 & 9 (Ages 14 & 15)
All Age Groups
Only Boys
Only Girls
Co-ed
What is your Highest Level of Basketball Playing Experience:
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Please Select
Never Played
Play for Fun (Occasionally)
Played on Middle School Team
Played on High School Team
Played Club League
Played on Elite Team (BC Basketball, etc.)
Played College/University
Played Professionally
Please list all ACTIVE Coaching, Refereeing, and/or Youth-Related Certifications:
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Please provide your National Coaching Certification Program (NCCP) #:
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Please indicate your NCCP Basketball Training Pathway Program/Level:
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Please Select
NCCP Basketball FUNdamentals
NCCP Basketball Learn to Train (L2T)
NCCP Basketball Train to Train (T2T)
NCCP Basketball Train to Compete (T2C)
I don't have a NCCP Basketball Pathway Started
Please indicate your NCCP Basketball Training Pathway STATUS:
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Please Select
In-Training
Trained
Certified
I would like to pursue NCCP training
I hold a different coaching certification
Please list all ACTIVE First Aid Certificates or Certifications:
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Please list previous Coaching, Reffing, or Volunteer Experience:
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How would you describe yourself as a Youth Sports Coach, Assistant, or Referee? What is your Coaching, Reffing, or Assistant Coach philosophy (winning, having fun, discipline, teamwork, etc...?)
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Describe your previous work with Children & Youth Sports Programs? Describe your previous volunteer experience and how it fits with our Youth Sports Program/Camp?
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Have you ever been Formally Disciplined from a Youth Sports Program either as a Coach, Parent or Observer?
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No
Yes, please explain below:
Explain the discipline, restriction, limitations
Please provide two Coaching, Assistant, Reffing, or Volunteer References:
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Please list any children you have who are participating and registered in West K Hoops:
If selected to be a Coach, Assistant, Referee, or Volunteer with Westkhoops, do you agree to a Local Background Check (+18 Only)?
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Please Select
Yes
No
Job Ad - Part-Time Coach, Jr. Assistant, Referee
If selected for a PAID Position, what is your desired Salary?
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e.g., $10 - $25 per hour
Terms and Conditions
*
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