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Complete Registration Form
2024-2025 YBOC Coach
Position Applied
Boy's Head Coach - Basketball
Boy's Assistant Coach - Basketball
Girl's Head Coach - Basketball
Girl's Assistant Coach - Basketball
Cheer Head Coach
Cheer Assistant Coach
Division
REC
SELECT
CHEER
Grade Level
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
Other
Head Coach or Team Name
If you are applying as an assistant, list head coach or team name (if known)
Do You Authorize a Background Check?
Yes
No
Coach First Name
Coach Last Name
Phone
Email
NAYS Number
If known yet
NAYS Member Expiration
If known yet
Birthday
Address
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code
Do you have a valid driver's license?
Yes
No
Driver's License Number
Driver's License Issuing State
Occupation/Employer
Social Security Number
xxx-xx-xxxx
Criminal History
Yes
No
Do you have pending charges, been convicted of, or plead guilty to any crime(s)?
Criminal History
If YES, describe each charge in full
Do you have a child(ren) in YBOC?
If YES, list name and grade of each child participating.
Coaching Experience
List all coaching experience including type of sport, age, level, dates, and city or town where you coached.
Working with Children or Youth
List any activities in which you have been involved in working with children or youth
Participation Refusal
Have you ever been refused participation as a parent or coach in any youth programs? If YES, explain.
Three References
List name and phone number of three references (other than spouse or family member)
Why do you want to coach?
Coaching Philosophy
Briefly describe your coaching philosophy.
Comments
Signature
By typing your name, you authorize investigation of all statements contained herein and affirm all information is correct.
Waivers
Background Check Authorization
"I authorize investigation* of all statements contained herein and all information concerning previous coaching assignments and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from the information furnished."
The position of Head Coach or Assistant Coach, is an appointed position upon the approval of the Board of Directors of Roger County Sports and/or Youth Basketball of Claremore and any person approved and designated as such will hold that position for no definite period of time and may regardless of the date of approval of position, be terminated at any time without prior notice for whatever reason(s) the Board of Directors deems necessary.
*Please note: All applicants will be subjected to a background check.
NOTE: Rogers County Sports and Youth Basketball of Claremore will not discriminate against any person on the basis of race, creed, color, national origin, marital status, gender, sexual orientation, or disability.
I agree
Please enter your initials to approve this waiver
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