Volunteer Coach Commitment Form
Please complete the form below. Once completed, next steps will be emailed to you.
COACH INFORMATION
Today's Date
*
-
Month
-
Day
Year
Date
Your Name
*
First Name
Last Name
Have you coached at CCSA in the past 12 months (2 seasons)?
Please Select
Yes
No
RETURNING COACHES: Please make sure your certifications are up to date (Background Check, Head Start, and SafeSport). They expire every 24 months. Questions, email us at doc@clarkcountysoccer.com
Select Head Coach Or Assistant Coach
Please Select
Head Coach
Assistant Coach
Head Coach gets 100% Refund for 1st child and 50% for additional children on same team. Assistant Coach gets 50% refund for 1st child and no refund for additional children on same team
If Assistant Coaching, list the name of the Head Coach you're pairing up with
Your Primary Email
*
example@example.com
Your Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Date of Birth
*
-
Month
-
Day
Year
Date
Your shirt size:
*
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Other
Your Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CHILD's INFORMATION
Name of child(ren) to be on coach's team(s). This is the child who's registration will be free for the season (i.e. your child, stepchild, grandchild, or partner's child)
*
Primary Address Of The Child(ren) you'll be coaching.
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is the BIRTH YEAR of the player (s) you'll be coaching?
Please type the player's birth year above (e.g. 2015)
What age group(s) are you interested in coaching:
*
U6
U8
U10
U12
U15
U19
This chart below provides information for practice time maximums and coaching time commitment expectations as outlined by US Youth Soccer. Please review and indicate you acknowledge the time commitment associated with your selected age group(s).
I acknowledge I have reviewed the above chart and understand the time commitment I am making to my team as a volunteer coach. Further I acknowledge that if I fail to meet the above requirements (min 1 practice per week for U8-U19 and min 80% game attendance) I will forfeit my coaching refund:
*
YES
I understand that in order to coach at CCSA, the information provided above will be used by CCSA leadership to complete a background check. I understand that if I do not meet the background check requirements, I will be ineligible to coach at CCSA.
*
YES
Signature
Submit
Should be Empty: