COACH APPLICATION - RECREATIONAL

PO Box 1031 | Fort Collins, CO 80522

970-484-3368 | Fax 970-484-6231
www.fortcollinsbaseballclub.org | office@fcbcmail.org
Instructions: Each question should be answered fully and accurately. Please print or type.

FULL Name:

Hm Phone:

(Must have full legal name, including middle name)

Mailing Address:

Wk Phone:

City/State/Zip:

Cell Phone:

E-Mail (required):
Do you possess a valid driver's license?

Yes

No

Background Check required for all applications: Social Security #

Are you age 18 or older?

Yes

No

Date of Birth (required)

Have you lived in Colorado for less than three years?

(If yes, please give last place of residence)

Yes

No

Are you a citizen of the United States or do you have a valid work permit?
Have you ever been convicted of a felony criminal offense?
Have you ever been convicted of a misdemeanor offense?

Yes
Yes
Yes

No
No
No

If your answer is "Yes" to either of the above conviction questions, please explain the date, location, nature, and facts
surrounding each conviction.

League: Current Grade as of registration choose the league for the grade your child is currently in.
Level 1

] Pre-Kindergarten

(T-Ball)

(Adv T-Ball/Soft-Toss)

] Kindergarten

Level 2

] 3rd Grade (Modified Ball)

Level 4

] 7th /8th Grade (High School Rules)

] 1st Grade

(Coach Pitch)

] 4th Grade (Modified Ball)

[

] 2nd Grade

(Player/Coach Pitch)

] 5th / 6th Grade (Modified Ball)

] 9th 11th Grade (High School Rules)

School Preference:

Online Concussion Training Course

All Coaches for 3rd Grade and older must complete the State-Mandated Online Concussion Training to Coach with FCBC. Go to
http://www.cdc.gov/concussion/HeadsUp/youth.html and take the test. Each Head Coach must provide a copy of the certification
to FCBC. If you have already taken the online course for a winter coaching position you may give that copy to us.

Continue to Page 2

Did you coach with FCBC last season? If Yes, what team and were you the head coach? Team Name, League/Age coached.

Reference from last coaching position:

Phone:

Relationship to Coach:

Have you ever played organized baseball?

Yes

No

If Yes, to what level:

What other coaching/teaching experiences do you have that would be relevant to this coaching position?

As a Volunteer Coach with FCBC, Coaching Clinics and Meetings are required to be a Head Coach. Are you willing to
attend Coach Clinics in May?
Yes
No
If No, please explain.

Please provide a basic sample practice outline for (1) day for players in the grade you are volunteering to coach.

Application Certification
I certify that all statements made in this application are true and complete and authorize Fort Collins Baseball Club to
investigate all statements made as a part of this application and to secure any necessary information from references and law
enforcement agencies.
I hereby release all of those persons, references, agencies and Fort Collins Baseball Club from any liability arising from their
giving or receiving information about my employment, qualifications, or criminal record.
I understand that any false answers or statements or misrepresentations by omission made by me as part of my application
will be sufficient for rejection of my application or my immediate suspension or discharge should one be discovered after I
am coaching a team. FCBC reserves the right to do background checks.
I hereby acknowledge that I have read and understand the preceding statement.

Signature / Date