Prospect Lake Soccer Club - Cordova Bay Soccer Club
Team Officials Application Form 2003-2004
Personal Information
Last Name
First Name
Address
City
Postal Code
Home Phone
Work Phone
Fax
E-mail
Previous Position
Coach
Asst. Coach
Manager
Team
Division
Position Applied For
Coach
Asst. Coach
Manager
Boys
Girls
Division:
U
Level:
Copper
Bronze
Silver
Gold
Name of child you wish to be placed with
Coaching Experience
Number of years
Where
What ages
Where
What ages
Where
What ages
Indicate which level of the National Coaching Certification Program you have achieved:
Theory
Technical
Team Officials are encouraged to gain Level 1 certification in their first year of coaching Mini soccer. Those wishing to coach U12 to U18 are advised to obtain Level 2 certification as this is the minimum requirement for BC Cup play. Funding for certification is provided by the club.
Do you wish to participate in certification?
References
First time applicants provide two references as to your character and suitability to coach youth.
Name
Address
Phone
Name
Address
Phone
Have you previously completed a "Volunteer Screening Form" and a "Consent for Criminal Record Search" for Prospect Lake Soccer Club or Cordova Bay Soccer Club?
Yes
No
When?
Team Officials with the Prospect Lake Soccer Club and Cordova Bay Soccer Club are expected to comply with all regulations outlined by BC Soccer Association, the BC Coaching Association's Code of Conduct, the clubs Code of Conduct and any terms of reference that may be periodically approved by the Board of Directors as relates to your duties.
Signed
______________________
Date
______________
Complete, print and Return to: Box 5000, 4466 West Saanich Rd., Victoria, BC V8Z 3E9
