Coach Registration

First name

Last name

Phone #

Email address

Jersey Size

Gender

Birthday

Year

Month

Day

Allergy & Medical Information (n/a if none)

Have you completed Safe Sport?

If Yes, which year was Safe Sport completed

NCCP# (If Available)

Home Address:

House Number

Street Name

City

Postal Code

Emergency Contact:

Full Name

Phone#

Email address

If you have a registered player, please complete this section:

Player 1 Full Name

Player 2 Full Name

Player 1 Gender

Player 2 Gender

Player 1 Birthday

Player 2 Birthday

Player 1 Division

Player 2 Division

If you have more players, please advise us via email at info@chemainusbaseball.ca

Important details:

I understand that a Criminal Record Check is required for this application *

I have read and signed the BC Minor Baseball Waiver *

I have read the Photo Consent & Player Release Form *

Signature

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