Fearless West Coast Soccer Camp Staff Coach Application
Please print this page and send to: Fearless West Coast Soccer Attn: Registration 37 Coso Ave. San Francisco, CA 94110 Name _______________________________________ Date of Birth _______________________________________ Gender M F SSN # _______________________________________ E-mail address _______________________________________ (make sure this is correct to receive your application acknowledgement) Mailing Address _______________________________________ _______________________________________ Home Phone ( ) _______________________________________ Mobile Phone ( ) _______________________________________ Work/School Phone ( ) _______________________________________ Shirt size XL/L/M/S other_____ Shoe size _____ Short Size XL/L/M/S other____ Are you CPR certified Y/N Have you Attended Fearless Soccer Camp as a player or Coach Y/N What Year? ____________ Coaching Certifications and credentials: Length of time you have coached: ______ years Do you have any coaching licenses y/n if yes please check the following that applies. NSCAA license y/n ___ A Level ___ B ___ C ___ D ___ E ___ Specialty or Goalkeeper certification List other coaching licenses and dates completed _______________________________________ _______________________________________ List at least 2 current teams/individuals you are coaching and give Team/ Individual Name _______________________________ Reference Name ______________ Phone ( )_______________ Team/Individual Name_______________________________ Reference: name______________ and phone #( )_______________ Please list other camp staff experience you have within the past 5 years 1 _______________________________________ 2 _______________________________________ 3 _______________________________________ Please list the levels you have coached at: ___ Olympic/ National/Professional level ___ Collegiate level D-1, D-2 D-3 Junior College ______________ ___ Regional ___ ODP ___ High School / Competitive Club ___ Youth Recreational ___ Other_______________________ Please List Coaching honors/ highlights/ specialties below ________________________________________________________ ________________________________________________________ Playing Experience and Accomplishments: ___ Professional level of play who what year(s) ___ Olympic/ National Team ___ Semi- Professional ___ Collegiate School (what level list awards/honors received) ___ Regional National pool ___ State Team ___ Club Select Team/ Name of team ___ High School Please list awards for the above (All Conference, All American, MVP, etc.) ________________________________________________________ ________________________________________________________ Availability and Preferences: List Age level you prefer to work with: ___ Co-Ed Ages 5-7/8-10 11-13 ___ Girls Ages 14-Adult ___ Boys 13-18 Please check our schedule and tell us what camps you are available to work ________________________________________________________ ________________________________________________________ Who Recommended you to Our Camp/How did you hear about us? ________________________________________________________ ________________________________________________________ Please list qualities and assets you would contribute to our program and explain why you feel you are a quality candidate for our program. ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________