Toca Juniors FC Application Form

1. Applicant Name*

First NameMiddle NameLast Name
2. Birth Date*

MonthDayYear
3. Gender*

FemaleMaleOther
4. Primary Phone Number:*
5. Other Phone Number:
6. E-mail Address:*
7. Address:*

Street Address

Street Address Line 2

CityState

Zip Code
8. Have you ever been convicted for any crime involving physical violence or sex related offenses?*

YesNo
9. Have you read the Toca Juniors FC Policy for the Prevention and of Abuse or Sexual Misconduct? *

YesNo
10. Have you completed the Abuse Awareness Training administered by Abuse Prevention System?*

YesNo
11. Do you give your consent to run a background check?(Administered by Abuse Prevention System)*

YesNo
12. Role(s) with the Club:*

Head CoachAssistant CoachParent CoachTeam ManagerTeam TreasurerBoard MemberVolunteerOther
13. Relationship(s) to the Club:*

Minis Training ProgramU10/11 Boys Training ProgramU12 Boys Training ProgramU14 Boys Training ProgramHS Boys Training ProgramU10/11 Girls Training ProgramU12 Girls Training ProgramU13/14 Girls Training ProgramU15 Girls Training ProgramOther
14. Years in Toca Juniors FC:*
If less than 1 year, type 1.
15. Describe any comnents you would like to share:
As an adult participant in Toca Juniors FC Programs I consent to a criminal records check and understand that my approval as a Toca Juniors FC adult participant (volunteer, coach, board member, administrator, etc) is contingent upon the succesful completion of a criminal records check. By this agreement, I hereby consent to criminal records check and I certify I have read the document Policies and Procedures on Prevention and of Abuse or Sexual Misconduct.
I understand and agree to the above.
Should be Empty: