PLYMOUTH SOUTH YOUTH FOOTBALL
AND CHEERLEADING
APPLICATION FOR COACHES, ASISTANT COACHES, & ADMINISTRATORS
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last name first name and middle initial maiden name
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Date of birth social security number home phone
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Street address city/town state and zip code
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e-mail address cell phone employer
Previous residences for the past five years:
City______________________________ state___________________
City______________________________ state___________________
2. Experience in football/cheerleading:
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I understand that:
1. In applying for a Plymouth South Youth Football position, the information which I have furnished on this form is subject to verification, which will include a criminal history check (CORI) from the Central Registry of DSS for child abusers, and/or request of sexual offender listing verification. The applicant hereby authorizes Plymouth South Youth Football to obtain such information from the appropriate municipal, count, state or federal agency. This information will be kept in a secure location and appropriately destroyed when no longer needed.
2. If Plymouth South Youth Football comes in possession of verified information that a volunteer has a history of complaint(s) of physical or sexual abuse of a minor, Plymouth South Youth Football will deny participation in its program. Plymouth South Youth Football may deny membership to any person, upon review of unordinary circumstances or events, at the Board’s sole discretion. If for any reason you are denied membership you have the right to appeal the decision to the PSYF Board of Directors.
Signature___________________________________________ Date________________________________