Upward Basketball Coach and Referee Application
      YES, I plan to coach Upward Basketball.        YES, I plan to referee Upward Basketball.	
Section 1
Name
Mailing Address
City	State	Zip
Phone (day)	(evening)	 (cell)
Email Address
Are you a member of a local church?	Yes	No	If yes, where?
Gender:	M	F	Date of Birth	/	/
Section 2 (please circle)
	1.	Mark which league you prefer to coach with a “C.” Mark which league you prefer to referee with an “R.” Which 
evaluation will you attend?
			Division	Boys	Girls	Evaluations
			Kindergarten	(Co-Ed)	Date:	Time:
			1st and 2nd Grade			Date:	Time:
			3rd and 4th Grade			Date:	Time:
			5th and 6th Grade			Date:	Time:
	2.	What is your preferred practice day?     M     T     TH     F 	Second choice?	M     T     TH     F
	3.	We will schedule practice times by age division, with the younger divisions having the earlier time slots. Please explain 		         any work/commute limitations on practice times. (ex. not home before 6pm, early work schedule requires 8pm 	               	         bedtime, etc.)   ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
	4.	What is your shirt size?    MEN:     S     M     L     XL     XXL     XXXL     WOMEN:     S     M     L     XL    XXL     XXXL
	5.	Please list your children who will be playing in this year’s Upward Basketball league, if applicable.
			Child’s Name	Grade	Gender	I plan to coach my child’s team
			M	F	Yes	No
			M	F	Yes	No
			M	F	Yes	No
	6.	Have you ever coached Upward Basketball before?     Yes     No
	7.	Have you ever refereed Upward Basketball before?     Yes     No
	8.	Have you made a personal commitment to Jesus Christ?     Yes     No
		Please share a little about your relationship with Jesus (use the back of this application if you need more room).
	9.	Do you know of someone who might be interested in coaching or refereeing Upward Basketball this year?
		Name	Phone	Name	Phone	

	10.	I will attend the mandatory coaches/referees training session on Saturday, Dec. 7th at 9am.	   
I understand that any negative personal habits that I have (smoking, alcohol, profanity, etc.) may have a negative effect on a child’s spiritual development. Understanding that the children on my team have been placed under my guidance, I commit to setting a worthy behavioral example for them to look to.
Coach’s and/or Referee’s Signature	Date