2151 West 13th * P. O. Box 1966, Casper, WY 82602 - (307) 234-7087, Fax (307)234-4394
Last Name:First Name: MI:
Mailing Address:
City:State: Zip:
Home Phone: Work Phone: Cell Phone:
Email Address:
Children playing in league this year:
Name:Age:Team:
Do you wish to manager or coach this year? Manager Coach Either
Do you wish to manage or coach the same team this year? Yes No, I will move up a division
Do you have anyone in mind to assist you? Yes No
If yes, name: Phone: Position: Manager Coach
Have you ever been convicted of a felony? Yes No
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, 2008.
*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. The Background Investigation Consent form must also be completed.