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					                                         Anaheim
  o     Football        o   Cheer          Pop
  o     Head            o   Assistant
                                         Warner
                                          Coach
                                        Application

Team                                             Position
Name                                             Date
Address                                          Home Phone
City & Zip                                       Work Phone
Occupation                                       Cell Phone
Social Security #                                Driver’s License #
E-mail address                                   Date of Birth

  IF YOU NEED ADDITIONAL SPACE TO ANSWER THE QUESTIONS, PLEASE
  ATTACH AN EXTRA SHEET OR USE THE BACK OF THIS FORM.



        1. List your previous experience playing and at what level.



        2. Please list your experience as a football coach and at what level.



        2. From you’re past coaching experience or your involvement with youth
            sports, please at list two references.

Name                                             Name
Address                                          Address



Phone                                            Phone

      4. What do you believe are coach’s responsibilities?
 5. Outside of having a child playing in the Anaheim Pop Warner Football league
    why do you want to coach?




 6. In detail please outline your (2) two-hour practice. From conditioning to full
    contact.




 7. Are you aware of the financial responsibility to this league? Yes         No




 8. In detail please outline the fund raising activities and provide the league with
    a proposed budget for this up coming season.




 9. Are you or any one on your staff, first aid and CPR certified?      YES     NO

   NAME of person that is certified:



   First Aid Certified Exp. Date:          CPR Certified - Exp. Date:



10. Have you ever been removed from a coaching staff? (If yes, please explain)




11. As a coach, have you ever been suspended? (If yes, please explain)
12. Have you ever been convicted of a felony? (If yes, please explain, and give
dates)




13. Please indicate the age level or division of play where you would like to coach,
rank your choice from highest priority to lowest (1,2,3…)




            Division                Ages                  Rank
            Cub (Flag)**            5&6
            Jr. Mighty Mite
                                    7, 8
            Mighty Mite
                                    7, 8, & 9
            Jr. Pee Wee
                                    8, 9, 10, & 11
            Pee Wee
                                    9, 10, 11, & 12
            Jr. Midget              10, 11, 12, & 13
            Midget                  11, 12, 13, 14 & 15

Most if not all teams will have cheer squads. While the team will have a Head
Cheer Coach, the Team Head Coach is responsible for the entire team, including
the cheer squad.

13. I have read and understand the attached “Requirements for Coaches” & the
Leagues CODE OF CONDUCT.



Signed:                                                            Date:

                         (Applicant’s Signature)




Please return this application, when complete, to:          Anaheim Pop Warner
                                                            1412 S. Amberwick Ln.
                                                            Anaheim, CA 92804



NOTE: The selection committee or the Board of Directors without comment may
          decline Applications.



                Please submit a recent picture of your self with this application.

				
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