Want to become a Coach? Just print out the form and email it to infolodibobs@gmail.com. 

 Date Received_____________ 

LODI BOOSTERS OF BOYS/GIRLS SPORTS 

1145 S. Ham Lane, Lodi CA 95240 

YOUTH SPORTS COACHING INTEREST FORM 

SPORT LEVEL ____________________________________________________________________

I am requesting to be a: □ Head Coach □ Assistant Coach 

Public Resources Code 5164 requires the Lodi Boosters of Boys/Girls Sports to screen those volunteers having supervisory authority over minors through the  Department of Justice’s fingerprinting process. In compliance with current law and as part of the BOBS obligation for due diligence in  screening people who work with children and act on behalf of the Lodi Boosters of Boys/Girls Sports, you will be required to be fingerprinted if assigned as a  head coach or assistant coach. A prospective volunteer may be rejected if determined to be a current abuser of drugs or intoxicating  liquor, conviction of a crime involving moral turpitude, or any crime which would reasonably be expected to affect the applicant’s ability  to perform the duties of the position applied for or which could reasonably be expected to reflect adversely on the mission of the BOBS.  The BOBS shall retain any information gathered during the process in confidence. 

Name email: 

 (First) (Middle) (Last) 

Address Cell/Home Phone City Zip Work Phone 

Have you ever been convicted by any court of an offense? □ Yes □ No 

If yes, list all offenses you were convicted of (or common name of offense) and the penal code section you were convicted of violating.  Please place this sheet of paper in a sealed envelope and attach to application. Conviction is not necessarily disqualifying. You may  omit: a) traffic violations for which the fine imposed was $50 or less; b) any offense committed prior to your 18th birthday which was  finally adjudicated in juvenile court or under a youth offender law; c) any incident that has been sealed under Welfare and Institutions  Code Section 781 or Penal Code Section 1203.45. A “Yes” answer is not an automatic bar from employment. 

The B.O.B.S. youth sport programs provide an enjoyable learning environment for youngster’s physical, social and  personal development. The responsibility of the volunteer coach is to teach responsibility and commitment, develop sport skills, teach  cooperation, develop positive attitudes toward authority, and to provide a fun and enriching experience. Coaches assume a role as  teacher and carry out lesson plans which develop skills through progressive teaching, emphasizing positive sports values and  encouraging life long interest in the sports in which they participate. 

By signing below, you agree that: 1) the position shall be for that sport season; 2) you recognize and agree with all duties and  responsibilities as established by B.O.B.S.; 3) you agree to use your best effort in executing the obligation of a coach for  B.O.B.S. 

________I certify that the statements made by me in this application are true, complete, and correct to (Initial)         the best of my knowledge and belief and are made in good faith. I understand and agree that  misstatements and/or omissions of material fact will be a basis for rejection of this  application or applicant. 

 Coaches may have to be interviewed and will be contacted when they are assigned a team. 

Please list your children (if any) that will be participating in the program you are requesting to coach. 

 NAME SCHOOL AGE, BIRTH DATE & GRADE 

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

  COACHING BACKGROUND

Have you coached this sport before □ Yes □ No Number of years  

What team did you coach most recently?

Please describe your coaching related experiences. Include paid and volunteer work.

Did you coach a Lodi Parks and Recreation/B.O.B.S. team last year? □ Head Coach □ Assistant  If head coach, who was your assistant? 

Name Team Name Level ٱ Boys ٱ Girls What other sports have you coached? 

PLEASE LIST YOUR PREFERRED COACHING ASSIGNMENT:  ______________________________________________

TRAINING BACKGROUND 

Have you had any formal training as a coach? □ Yes □ No If yes, please describe (for example, PE degree, coaching courses,  etc.) 

Have you attended any training clinics □ Yes □ No Year Sport 

Clinic Name(s) 

Do you have a current CPR/first aid card? □ Yes □ No Year completed 

RELATED SPORT INFORMATION 

Have you played this sport on an organized team? □ Yes □ No Number of years Level 

REFERENCES 

Name Address Telephone