Coach Application

Touch Line Soccer Application

Coach Form

Fall 2010 / Spring 2011

First Name:	*
Last Name:	*
Street:	*
City:	*	State:	* Zip:*
Phone:	*
Mobile:		Email:	*
Evening Phone:		2nd Email:
Birthdate:	*		* required
	MM/DD/YY

Highest Coaching License : Other or Issued by:

I would like to coach the following age groups (you may select more than one):

	Boys	U-4	U-6	U-8	U-10	U-12	U-14	U-16	U-18
	Girls	U-4	U-6	U-8	U-10	U-12	U-14	U-16	U-18

Which age group is your preference:

I am willing to be an assistant coach:

I have a son/daughter playing in the MYS program at the following levels:

	Boys	U-4	U-6	U-8	U-10	U-12	U-14	U-16	U-18
	Girls	U-4	U-6	U-8	U-10	U-12	U-14	U-16	U-18

Please explain your reason for wanting to coach a MYS team:

Please summarize your experience in coaching, playing, or anything else to be considered by the Coach Selection Committee:

Please state any conditions to your application. (Must coach son/daughter, must coach “A” team, will only coach if certain assistant is assigned, will only coach if certain player is assigned, etc.):

I agree to abide by the rules and regulations and support the values of the Middleton Youth Soccer Association. I agree to abide by the rules and regulations of the Essex County Youth Soccer Association:

Please initial below indicating you have read and agree to the above statement: