Name:
Email:

Please select the division and position you are applying for
(i.e. PeeWee - Asst Coach):

Division:

Position:

If the division/position of your choice is unavailable, would you be
open to another division? Yes No

Date of Birth :	(mm/dd/yyyy)
Address:
City State ZIP :
Home Phone:
Work Phone:

Name(s), Age(s), & Activity of Children in Benicia Youth Football & Cheer:

Name	Age	Activity

Have you been convicted of any felony? Yes No
If yes, please provide details below:

Please state in detail your prior experience that would benefit and assist
you in performing your duties and activities for which this
application is made:

By submitting this information you certify that the facts contained in this application are true and complete to the best of your knowledge and understand that, if approved, falsified statements will be grounds for dismissal. You authorize investigation of all statements contained here-in 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 furnishing same to you.

The position of head coach or assistant coach, is an appointed position upon the approval of the board of directors of Benicia Youth Football & Cheer and regardless of the date of approval of position, may be terminated at any time without prior notice for whatever reason(s) the board of directors deems necessary.