Coaches Application Form (Port Dover Minor Baseball)

Print Coaches Application Form
  1. Port Dover Minor Baseball Coach Application Form

    Once Completed it will be automatically Emailed to the Coach Application Manager

Coaching Applicant Information
  1. RadDatePicker
    Open the calendar popup.
    Format MM/DD/YYYY
  2. Example: ###-###-####
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  5. State NONE if no Medical Conditions
Coaching Experience, Background
  1. Are you currently under probation or suspension from coaching duties within any school or community sport program?
  2. Do you have criminal charges pending?
  3. Have you ever been convicted of a criminal offence?
  4. If yes to any of the above 3 questions, please provide details.
Coaching Qualifications
The following courses are required for Rep coaches only. Refer to the OBA Certification Information under Coaches Corner on the website homepage for details.
  1. 7 digit number assigned by NCCP

  2. Check all that Apply. Refer to Coach Requirements for OBA Coaching Certification details.
Team Preference & Discipline
  1. Select Team from List
  2. Comments with regard to teams
Please provide the names and contact information for two references. Note that these individuals may be contacted for reference information on your coaching application.
  1. Example: ###-###-####
  2. Example: ###-###-####

    The email id(s) provided above will be used for coach communication by PDMBA throughout the baseball season.  Please notify PDMBA to have an email id removed from the coaches mail list if required.
  2. RELEASE AND DISCHARGE (please read carefully)

    I hereby give my permission that a Criminal Record Check be conducted on me  prior to commencing any coaching activity with  PDMBA .

    I hereby certify that the information provided on this application is complete and correct.

    If selected as a coach for Port Dover Minor Baseball Association (PDMBA), I hereby agree to:

    Teach and display fair play and sportsmanship and expect the same from all my players and coaching staff.

    Abide by all applicable Baseball Canada/OBA/SCBA/PDMBA constitution, bylaws, rules and regulations.

    Provide a list of my team officials (Manager, Assistant Coaches) to PDMBA for approval after the final try out.

    Participate in Winter Ball sessions between January and May at Lakewood Elementary School or designate a person
     to coach if you cannot attend.

    I agree to obtain a current Police Criminal Record Vulnerable Sector Check prior to the first winter ball session


    I authorize Port Dover Minor Baseball and/or its staff, associates, assistants, or subcontractors to use photograph(s), video and other media image provided for any Port Dover Minor Baseball  promotional, educational or other pertinent uses. I also agree to Port Dover Minor Baseball  using any images gathered by photographers, and or videographers supplying images to Port Dover Minor Baseball . I understand that some photographs with names will appear in local press publications for example when reporters attend games, practices or other events together with Annual Award Ceremonies.

    These images may include, but are not exclusive to, club, coach, athlete and/or parent, and/or volunteer submissions by various member associations of Port Dover Minor Baseball.

    I authorize Port Dover Minor Baseball  to permit the use and display of photographs and/or recordings of the named minors in any Port Dover Minor Baseball  publication, multimedia production, including video and web usage, display, or advertisement.

    I agree that Port Dover Minor Baseball may use name, likeness, or information supplied by the undersigned.

    The undersigned releases and forever discharges Port Dover Minor Baseball and its officers and employees from any and all claims and demands arising out of or in connection with the use of said photographs / recordings, including but not limited to, any claims for invasion of privacy or defamation.

Coaching Applicant Submission - Electronic Signature
Enter name and date of submission which is deemed to be an electronic signature
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    Open the calendar popup.
    Format MM/DD/YYYY
Human Validation