PG. Co. R/C Racing League Coach Intake Form
Welcome! Please fill out this form to help us understand your interests and background.
Section 1: Personal Information
Coach Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Coach Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Coach Email
*
example@example.com
Grade Level of your team that you will be coaching
*
Please Select
Middle School Age Youth
High School Age Youth
Are you a current teacher, employee with parks and recreation and or Prince George's County
*
Please Select
Yes
no
Name of school, recreation center or boys and girls you are affiliated with or NA
*
I am willing to coach my team and participate in mandatory events related to the league
*
Yes
No
Tell us about your interests in STEM.
*
Section 2: Background & Eligibility
Have you ever been convicted of a criminal offense?
*
Yes
No
If yes, please explain
Have you ever been charged with or convicted of any offense involving a minor?
*
Yes
No
If yes, please explain
Are you currently listed on any child abuse or sex offender registry?
*
Yes
No
Have you ever been barred or restricted from working with youth?
*
Yes
No
If yes, please provide details
Have you ever been terminated or asked to resign from a position involving youth due to misconduct?
*
Yes
No
If yes, please explain
Section 3: Commitment to Youth Safety
If you are not a Prince George's County Employee or have not had a background check performed, are you willing to undergo a background check?
*
Yes
No
Do you agree to abide by the league’s Code of Conduct and Youth Protection Policies?
*
Yes
No
Have you completed any youth protection or mandated reporter training in the past 3 years?
*
Yes
No
Do you have any concerns or limitations affecting your ability to coach?
*
Yes
No
If yes, please explain
Instructions: All information provided in this form is confidential and will be used solely for the purpose of evaluating your suitability as a coach. Please answer all questions truthfully and completely.
Signature Section
Signature I affirm that the information provided above is true and complete to the best of my knowledge. I understand that any false statements or omissions may disqualify me from coaching in this league.
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Continue
Continue
Should be Empty: