Application To Coach for HPHoops

* Required Fields
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*Name
*Date of Birth (MM/DD/YYYY)
mm/dd/yyyy
*Driver License Number
*State of issuance:
*Address
*City
*State
*State
*Zip Code
*Primary Phone Number
*Secondary Phone Number
*Email Address
*Do you have a child(ren) competing with us?
 Yes 
 No 
*Select the number of years you have coached.
*Have you coached with us before?
 Yes 
 No 
Experience
In the box below, please list all organizations you have coached with and describe why you want to be a coach.
*Experience

Police Record
Have you been arrested for, charged with, or convicted of any offense as an adult?
*Record
 Yes 
 No 
If yes, please explain.
Coaching waiver
Conditions/Indemnification/Consent
All HPHoops Coaches are required to attend a Coaching Certification course prior to the beginning of the season.  HPH is an instructional organization with a Player Participation Rule.  All coaches must agree to follow the given rulebook and all guidelines that are included.
 
I hereby understand the HPHoops Rulebook and acknowledge this is a first warning, the first violation will result in written censure and suspension. Any additional violations of the HPHoops Rulebook may result in termination of coaching privileges.  
 
I hereby give my full consent and permission to High Plains Hoops Basketball in order to obtain information relating to my criminal history and any other applicable records. The records as reviewed by the reporting agencies may include but are not limited to arrest, conviction, driving records, plea bargains, and deferred adjudications. I understand that this information will be used in part to determine my eligibility for as a volunteer and/or board member or officer within this organization. I also understand that I will have an opportunity to review the records as received by High Plains Hoops and I have the right to dispute or clarify the records that are received by the League. I also understand that the records received could contain information presumed expunged.  I do for myself, my hires, executors and administrators, hereby remise, release, and forever discharge and agree to indemnify High Plains Hoops, each of their officers, board members, volunteers and agents and hold them harmless from and against any and all causes and actions, including but not limited to: suits, liabilities, costs, debts, and sums of money, claims, and demands whatsoever (including claims for negligence, gross negligence, and/or strict liability) and any and all related attorney's fees, court costs, and other expenses resulting from the investigation of my background in connection with my application to serve.  As indicated by my electronic signature below, I have read and agree to these requirements, have provided accurate information, and fully understand the consent for the background check.

 

I ACCEPT AND SIGN THIS FORM VOLUNTARILY.

*Electronic Signature
 Select yes to indicate agreement. 
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