Competitive Coaches Application – London Ramblers Basketball

Name*

First Last

Address*

Street Address City Postal

Cell #*

Email*

Birth Date*

MM

DD

YYYY

Select coaching position from menu below:*

Select gender you would like to coach:*

Select age group(s) you would like to coach.*

U10
U11
U12
U13
U14
U15
U16
U17
U19 Women/Men

Are you willing to complete a police vulnerable sector verification to be able to volunteer/coach?*

Yes
No

**Cost of police vulnerable sector verification will be reimbursed by London Ramblers Basketball once we receive an original copy.** **A new VSV is required every 3 years.**

NCCP Coaching # - (If no CC number available please state N/A.)*

NCCP/Safe Sport Certification - Please check all that you are certified in.*

Level 1 - Learn to Train Certified
Level 2 - Train to Train Certified
Level 3 - Compete to Train Certified
Making Ethical Decisions Certified
Respect In Sport Training Certified
None

Are you willing to take a weekend certification course to be able to coach a competitive team?*

Yes
No

Note: All coaches must be willing to get certified at appropriate levels to coach a competitive team. Cost of the course will be reimbursed by Quest for Gold and London Ramblers Basketball once the course has been completed and invoice provided.**

Please list any previous volunteer or coaching experience with youth. (If you have volunteered/coached with Ramblers previously no need to complete - state NR.)*

Concussion Policy*

I acknowledge having read, understood and agree to the concussion policy.

Click here to read the Concussion Policy

Competitive Coaches Code of Conduct*

I acknowledge having read, understood and agree to adhere to the competitive coaches code of conduct.

Click here to read the Coaches Code of Conduct

List 2 references of which at least one has knowledge of your participation as a volunteer in a youth program. (If you have volunteered/coached with Ramblers previously no need to complete- state NR.)

Name

First Last

Phone# and/or email

Name

First Last

Phone# and/or email

Coaches/Volunteer Signature*

First Last

I confirm all information above is true and up to date.