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SYOSSET SOCCER CLUB
Intramural Coach Application Fall 2008/Spring 2009
PLEASE FILL IN ALL FIELDS!
Contact Information
Name - First
Name - Last
Street Address
City
State
Zip Code
Home Phone Number
Cell Phone Number
Work Contact Phone
Email Address
Confirm Email Address
Position Desired
Division
U4 U5
U6 U7
U8 U9 & U10
Route 135 League
Gender
Boys Girls
Position
Head Coach Assistant Coach
Coach With
Coaching Background

Highest Soccer Coaching License

Date of Highest Soccer Coaching License
Other Licenses / Certificates
References / Other
Have You ever been convicted of a crime Yes    No
If Yes, Explain
Name & Telephone No of References
Agreement
By checking this box and submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a coach any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
I have read and agreed to the Syosset Soccer Club Code of Conduct.
I have read and agreed to the Syosset Soccer Club Coach's Pledge.