2. Please click on the following link to read the "Volunteer Youth Sports Coach Application Packet".
   Volunteer Youth Sports Coach Application Packet

   **Reading this document is REQUIRED and should be read BEFORE completing this application!**

4. I have read the "Volunteer Youth Sports Coach Application Packet".*

   1. Yes
8. Which youth sport program(s) are you applying to be a volunteer coach for?*

   Please select all that apply.

   1. Spring Flag Football
   2. Fall Flag Football

   1. Spring Soccer
   2. Fall Soccer

   1. Summer Volleyball
   2. Winter Volleyball
12. First Name*
13. Middle Name*
14. Last Name*
16. Date of Birth*
    Date of Birth
17. Social Security Number*
19. Street Address*
21. City*
22. State*
23. Zip Code*
25. Cell Phone Number*
26. Alternate Phone Number
28. Email Address*
32. Employer Name (Company)*
33. Occupation*
35. Employer Street Address*
37. Employer City*
38. Employer State*
39. Employer Zip Code*
41. Employer Phone Number*
45. Please list any special professional training, certifications, skills, hobbies, etc.:*
    Including medical or CPR type of certifications.
46. Please list any community affiliations (clubs, service organizations, etc.):*
48. Please list any previous volunteer experience, including coaching and year(s):*
49. Do you have any children that participate in our athletic programs?*

    1. Yes

    1. No
51. If so, what programs does your child/children participate in?*
55. Do you have a Valid Driver's License?*

    1. Yes

    1. No
56. Driver's License Number*
57. Driver's License State*
59. Please upload a color copy of your Driver's License.*
    Can be either scanned and uploaded, or you may take a picture of your Driver's License to upload. ALL INFORMATION MUST BE READABLE AND VISIBLE!!
63. Have you ever been charged/ convicted or plead guilty to any crime(s)?*

    1. Yes
    2. No
64. If yes, please describe EACH in full:*
66. Have you ever been refused participation in any other youth programs?*

    1. Yes
    2. No
67. If yes, please explain any such situation in full:*
69. Please list the states that you have lived in, for any amount of time, over the past 10 years:*
73. Please list three references, with at least one of which having knowledge of your participation as a volunteer in a youth program.
75. Reference #1 First Name*
76. Reference #1 Last Name*
77. Reference #1 Phone Number*
79. Reference #2 First Name*
80. Reference #2 Last Name*
81. Reference #2 Phone Number*
83. Reference #3 First Name*
84. Reference #3 Last Name*
85. Reference #3 Phone Number*
89. Applicantion Authorization
    As a condition of volunteering, I give permission for the City of Lincolnton Parks and Recreation Department to conduct a background check on me, which may include a review of sex offender registries, child abuse, and criminal history records. I understand that, if appointed, my position is conditional upon the City of Lincolnton receiving no inappropriate information on my background and I understand that any misstatement or omission of information will subject me to disqualification as a volunteer. I hereby release and agree to hold harmless from liability the City of Lincolnton Parks and Recreation Department, its employees and volunteers, and any other person or organization that may provide such information. I also understand that, regardless of previous appointments, the City of Lincolnton Parks and Recreation Department is not obligated to appoint me to a volunteer position. If appointed, I understand that (prior to the expiration of my term) I am subject to suspension or removal by the Parks and recreation Department Director for violations of the City of Lincolnton Parks and Recreation Department's policies or principles. Please note that the City of Lincolnton and the City of Lincolnton Parks and recreation Department will not discriminate against any person on the basis of race, creed, color, national origin, marital status, gender, sexual orientation, or disability.
91. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you by the same force and effect as a handwritten signature, 3) you may still be required to provide a traditional signature at a later date, and 4) you are agreeing to the statement(s) above.

    1. I agree
93. Electronic Signature*
94. Signature Date*
    Signature Date
98. Coach's Code of Ethics Authorization
    I have read and hereby agree to the statements set forth in the "Coach's Code of Ethics" document.
100. Electronic Signature Agreement*

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you by the same force and effect as a handwritten signature, 3) you may still be required to provide a traditional signature at a later date, and 4) you are agreeing to the statement(s) above.

     1. I agree
102. Electronic Signature*
103. Signature Date*
     Signature Date
107. City of Lincolnton Administrative Policy Authorization
     I have read and hereby agree to the statements set forth in the "City of Lincolnton Administrative Policy" document.
109. Electronic Signature Agreement*

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you by the same force and effect as a handwritten signature, 3) you may still be required to provide a traditional signature at a later date, and 4) you are agreeing to the statement(s) above.

     1. I agree
111. Electronic Signature Agreement*
112. Signature Date*
     Signature Date
Leave This Blank:


114. 1. Receive an email copy of this form.
115. Email address

     This field is not part of the form submission.

116. Submit Submit and Print

* indicates a required field