Coach Application

Coaches

First Name

Last Name

Address 1

Address 2

City

State AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip

Social Security #

Phone (123-123-1234)

Cell (123-123-1234)

Email

Date Of Birth

Current Occupation

Employer

Employer Address

Special professional training, skills, hobbies

Prior Background Check

Yes

No

If Yes, Provide date and organization which completed the background check

Coaching Experience (include position(s) requested)

Do You Have Children in the camp?

Yes

No

If yes, list full name, camp location and grade

Special Certification (CPR, Medical, etc)

Do you have a valid driver's license?

Yes

No

Driver's License No.

State AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Have you ever been convicted of or pled guilty to any crime(s) involving or against a minor?

Yes

No

If yes, describe each in full

Are there any criminal charges pending against you regarding any crime(s) involving or against a minor?

Yes

No

If yes, describe each in full

Have you ever been refused participation in any other youth programs?

Yes

No

If yes, explain

Shirt Size S M L XL 2XL

Camps Interested in Working

2024 Taylor University (IN) Middle School Camp June 3-6

Please list three references, at least one of which has knowledge of your participation as a coach/position in a youth program.

Terms of Service *

I agree to the user agreement terms.

Full Name

Today's Date

After registering, please email a copy of a valid government issued photo. Please note that coaches will not be selected until we get closer to camp dates because we will not know how many coaches we need for each camp until campers have had an opportunity to register. You will be notified approximately 30 days prior to camp opening.

Questions?

For High School Camps, please contact:

Bill Lynch

Williammlynch54@gmail.com

812-679-8125

For Middle School Camps, please contact:

Coach Dury

georgedury@sbcglobal.net

(317) 590-5549

333 E. Ohio Street, Suite 200, Indianapolis, IN 46204