Casper Youth Baseball

Last Name:First Name: MI:

        Mailing Address:

        City:State: Zip:

Place of Employment:

Home Phone:   Work Phone:   Cell Phone:

Email Address:

I. Do you have any children that will be playing in CYB?  Yes      No

If "yes," list their names, ages, and last year's teams (if applicable) below.

Name:Age:Team:

Name:Age:Team:

Name:Age:Team:

II. Check the box of the position for which you are applying:

Manager                Coach                Either

III. Did you manage or coach a CYB team last year?   Yes      No

If "yes," were you a manager or coach?   Manager            Coach

Team Name:Division:

Do you wish to have the same team this year?   Yes      No

If "No," please explain:

IV. If you did not manage or coach in CYB last year or if you wish to manage or coach a different team, please answer the following:

What division would you like to manage/coach in?

Which team would you like to manage/coach?

Do you have a son/daughter already on a team in this division?   Yes      No

Will you have a son/daughter in this division this year?    Yes      No

V. Please list your baseball background, including coaching experience:

VI. Please list other experiences you have had working with children:

VII. Do you have anyone in mind to assist you?   Yes      No

If yes, Name:Phone:

Assistant's Position:    Manager    Coach

VIII. Other than above, do you know of anyone else who may be willing to manage or coach?

Name:Phone:

Manager or Coach:ManagerCoach

IX. Have you ever been convicted of a felony?   Yes      No

X. Have you ever been convicted of a crime against another person?   Yes      No

If answer to # IX or # X was YES, please explain:

*I understand that part of my duties as a Manager will include the return of all team equipment by September 1, 2010.

*I understand that each player is responsible for $155.00 in fees and is not eligible to play until full amount is paid.

*I authorize CYB to conduct a criminal background check before being given the authority to act as a manager or coach of any team and I agree to execute the attached Background Consent Release form.  I understand that failure to authorize and/or provide a criminal background check will result in immediate suspension. (IF YOU FILLED OUT A BACKGROUND CONSENT RELEASE FORM LAST YEAR, YOU DO NOT HAVE TO FILL ONE OUT THIS YEAR.)

Signature: ______________________________Date Completed by Applicant:

Print this form and fax, mail or deliver it to the CYB office by March 16th.  The Background Investigation Consent form must also be completed.