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.