Coach's Registration

Last Name:
First Name:
Street Address:
City:
State:
Zip Code:
Birth Date: (MM/DD/YYYY)
Birth City:
Birth State:
Birth County:
Phone Number:
E-Mail Address:
Position: Head Coach      Assistant Coach
Division:
T-Ball (4-5) Coach Pitch I (5-6)
Boys Coach Pitch II (7-8) Girls Coach Pitch II (7-8)
Boys Mustang (9-10) Boys Bronco (11-12)
Boys Pony (13-14) Boys Colt (15-16)
Girls Pigtail (10&U) Girls Feather (12&U)
Girls Galaxy (14&U) Girls Delta (16&U)
Shirt Size:
Adult-S Adult-M
Adult-L Adult-XL
Adult-XXL Adult-XXXL

By clicking the Submit button below, I authorize Stateline Youth Athletics to inquire of the courts and law enforcement agencies for possible pending charges or convictions against me.

-  I understand that this authorization is required for any person who is allowed employment or volunteer work status within the SYA organization.

-  I understand that any false information or omission of information will jeopardize my position with respect to employment or volunteerism.

-  I understand that information furnished or recovered as a result of any inquiry will be considered as part of an overall evaluation of my qualifications.
 

Page last modified Sunday, February 03, 2008