Upward Basketball Coach and Referee Application

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					                                 Upward Coach and Referee Application
                             and First Baptist Wylie Volunteer Screening Form

This form is to be completed by all applicants for any position involving the supervision or custody of
minors. It will help our church family provide a safe and secure environment for all preschoolers, children,
and youth who participate in our ministries and use are facilities.

Please check all positions you are interested in:
 Basketball Head Coach                                              Cheerleading Head Coach
 Basketball Assistant Coach                                         Cheerleading Assistant Coach
 Basketball Jr. Coach                                               Cheerleading Jr. Coach
 Referee
                                 Background Screening Consent
Applicant should complete all relevant information and sign and date the form.

I, ______________________________________, hereby authorize First Baptist Church Wylie and/or its
agents to make an independent investigation of my background that may include: references, character, past
employment, education, credit history (if applicable for position), adult criminal or police records, and motor
vehicle records including those maintained by both public and private organizations and all public records for the
purpose of confirming the information contained on my Application and/or obtaining other information which may
be material to my qualifications for service now and, if applicable, during the tenure of my employment or service
with First Baptist Church Wylie.

I release First Baptist Church Wylie and its agents and any person or entity, which provides information
pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information
obtained from any and all of the above referenced sources used. The following is my true and complete legal
name and all information is true and correct to the best of my knowledge:

Full Name (Printed)__________________________________________________________________

Maiden Name or Other Names Used_____________________________________________________

Social Security Number:______________________________ Date of Birth*: _____/_____/19_____

Present Address_____________________________________________________________________


How Long at Present Address?_________________________________________________________

Former Address_____________________________________________________________________


How Long at Former Address?_________________________________________________________

Please list all states and counties of residence since turning age 18:


(Please circle any of the following states in which you have lived: CA, CO, DE, LA, MA, SD, VT, WV, WY)

Driver's License Number: ___________________________________ State of License: __________

Signature of Applicant / Date

 *NOTE: The above information is required for identification purposes only, and is in no manner used as
qualifications for employment, internship, or service as a volunteer. First Baptist Church Wylie abides by all
applicable state and federal employment laws.
                                                                                                          Revised 07/23/10 wn
                              Upward Coach and Referee Application
                          and First Baptist Wylie Volunteer Screening Form

By choosing to coach an Upward sports team, you have shown an interest in making the difference in the
life of a child. I would like to take this opportunity to do a couple of things; first I want to thank you for
your interest in coaching this year. I would also like to ask you to take a few minutes to look over this
information sheet which outlines the requirements / expectations of all of our coaches and referees.

As an Upward coach or referee I agree to meet and uphold the following requirements and expectations as
set forth by the Upward Ministry.

    I will commit to attending a coaches training session. If I am unable to make a scheduled training
     session I will secure a time to meet with an Upward Ministry representative.
    I will commit to uphold and teach the rules of Upward Flag Football or Cheerleading to each of my
     players and their parents.
    I will commit to share the love of Jesus Christ with each player.
    I will commit to pray for each member of my team and their parents.
    I will support the referee with positive comments.
    I will demonstrate self-control in all situations.
    I will prepare for practices by having a practice plan.
    I will prepare for practices by reviewing the devotion provided in the coach’s book.
    I will distribute the practice stars at the end of each practice.
    I will distribute the game-day stars with enthusiasm and praise for each player at the end of the
    I will commit to teaching the fundamentals of the game.
    I will commit to understanding the circle of criticism and affirmation, taking the time to share this
     with parents of the players on my team.
    I will commit to communicating in a positive an upbeat manner with all of my players.
    I will commit to creating an open line of communication with my players parents, making sure to
     notify them of any changes in scheduling or special events that may be taking place.
    I will commit to ensuring the safety of all the participants.
    I will commit to attending the Awards Night Celebration at the end of the season.

I hope that you will prayerfully consider the responsibilities / expectations that have been outlined here as
you consider whether or not you would like to coach an Upward Flag Football team or Cheer Squad. The
expectations are high and the challenge is great but, the reward (though we may not see it here) is greater

Scott Phillips
Children’s Pastor
First Baptist Wylie

 For office use only –
Background Check Complete (date) _________________________
References Contacted – Comments
                                                                                                  Revised 07/23/10 wn
                              Upward Coach and Referee Application
                          and First Baptist Wylie Volunteer Screening Form

Coach Name:________________________________

Phone #:_______________________                Email:____________________________

1. What is your shirt size? S M L XL XXL
2. What is your preferred practice day? M T Th F
3. What is your preferred practice time? 6pm 7pm 8pm
(we prefer K-5 teams to practice at the 6:00 hour if possible)
4. What is your preferred cheerleading practice day? M T Th
5. What is your preferred cheerleading practice time? 6pm 7pm
6. Please list your children who will be participating in this year’s Upward League.
Child’s name                   Grade           Sex             I plan to coach my child’s team
_________________              _____           M F             Yes    No
_________________              _____           M F             Yes    No
_________________              _____           M F             Yes    No

6. Mark the league you prefer to Coach with a ‘C’. Mark the league you prefer to referee with an ‘R’.
League                 Boys            Girls           Cheerleading
Kindergarten           ____            ____            ____
 st    nd
1 & 2 Grade            ____            ____            ____
 rd    th
3 & 4 Grade            ____            ____            ____
 th    th
5 & 6 Grade            ____            ____            ____

7. Have you ever coached an Upward Sport or Cheerleading before? ___ Yes           ___ No
8. Have you ever refereed an Upward Sport before? ___ Yes         ___ No
9. Please share a little about your relationship with Jesus.


                                                                                                 Revised 07/23/10 wn
                     Upward Coach and Referee Application
                 and First Baptist Wylie Volunteer Screening Form

                 COACH TRAINING SESSION:

JULY 24TH : 11:30PM-1:30PM

AUGUST 21ST : 11:30PM-1:30PM


                                                                    Revised 07/23/10 wn

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