Youth Sports Coach Volunteer Application

Please correct the field(s) marked in red below:

The City of Victorville Recreation Division offers Youth and Pee Wee Sports programs to children ages 3-17 throughout the year. Opportunities are available for community members to Volunteer as coaches to get involved. If you would like to become a Volunteer coach in the Youth and Pee Wee Sports program, please complete the survey below and submit your application. Additional background checks will be required for approved volunteers. Thank you for your interest in supporting City programs.
1
Volunteer Name
 *
2

Address, City, State, and Zip

 *
3
Contact Phone Number
 *
4
Email Address
 *
5
Emergency Contact Name
 *
6
Emergency Contact Phone Number
 *
7
Have you ever been convicted of a violation or attempted violation of Section 243.4 of the Penal Code, a sex offense against a minor, or of any felony, which requires registration pursuant to Section 290 of the Penal Code?
 *
Have you ever been convicted of a violation or attempted violation of Section 243.4 of the Penal Code, a sex offense against a minor, or of any felony, which requires registration pursuant to Section 290 of the Penal Code?
8
Which Youth or Pee Wee Sport(s) are you interested in coaching?
 *
Which Youth or Pee Wee Sport(s) are you interested in coaching?
9
If you have a child enrolled in the program whose team you would like to coach, please give their name and age division.
10
Please describe any playing and/or coaching experience you have in the sport you want to coach.
 *
11

I have carefully read the Activity Waiver linked below, and fully understand its contents. I am aware that this is a Release of Liability and a Contract between myself and CSD and/or City and sign it on my own free will.

Recreation Activity Liability Waiver

 *
  1. To receive a copy of your submission, please fill out your email address below and submit.