Coaching Application

Last Name *

First Name *

Address *

City *

State *

Zip Code *

Social Security Number *

Driver's License Number *

Email *

Phone *

Which division would you like to coach in? (Select One) *

Are you applying as a Head Coach or Assistant Coach? (Select One) *

Have you ever been convicted for violation of any law, police regulation, or ordinance excluding minor traffic violations? *

If you have a record of convictions for any offenses other than minor traffic violations, as a part of the coaching process it is required that you disclose the information at this time. A conviction record is not an automatic bar from coaching; persons with conviction records may be able to coach. Each case is decided on its individual merit and conviction record. Coaches will not be able to begin coaching until the Ventura Buccaneers office has received clearance. Falsification of this form or omission of any conviction may result in your coaching application being disqualified.

Please list charge(s), date(s) and disposition(s). *

Signature: (Please enter name in CAPS) *

Date *

I accept the following terms *

I hereby agree to abide by the rules and regulation of the Gold Coast Youth Football League (GCYFL) and of the Board of Directors of the Ventura Buccaneers Youth Football Organization. I hereby agree to be fair and abide by the ethical rules and regulations of the Ventura Buccaneers Youth Football Organization. I certify that I am 21 years old and have not been convicted of any crimes which would be registered under Section 290 of the California Penal Code. I certify and declare under penalty of perjury that the foregoing is true and correct.