Pulaski Baseball

Full Name:* First Last (John Smith)

Date of Birth:* eg. 01/12/1983 (MM/DD/YYYY)

Gender:*

Street Address 1:*

Street Address 2:

City:*

State:*

Mobile Phone Number:* eg. ##########

Email:*

T-Shirt Size:* Sizing instructions for hats and jerseys

Hat Size:* Sizing instructions for hats and jerseys

Are you at least 18 years old?:*

Emergency Contact Full Name:* First Last (John Smith)

Emergency Contact Phone Number:* eg. ##########

Emergency Contact Relationship to Participant:*

Are you certified in First Aid?:*

Are you certified in CPR?:*

Have you ever been convicted or have charges pending of a crime (felony or misdemeanor)?:*

I agree to allow Pulaski Baseball, Inc. to conduct a background check as part of the application.:*

Do you wish to coach a LEAGUE or TOURNAMENT team?:*

Tournament Team you wish to coach:*

Do you wish to be a Tournament team Head Coach, Assistant Coach, or Parent Helper?:*

None

Head Coach

Assistant Coach

Parent Helper

League you wish to coach:*

Do you wish to be a League Head Coach, Assistant Coach, or Parent Helper?:*

None

Head Coach

Assistant Coach

Parent Helper

Do you have a child at this level?:*

Child Full Name:* First Last (John Smith)

Playing Experience (select highest level):*

What is you comfort level teaching baseball?:*

Please list any coaching experience: Sport, Level, Age etc.

What is a Concussion?:* Wisconsin State Law (WI Act 172, Statue 118.293) requires all youth athletic organizations to educate coaches on the risks of concussions and head injuries . The following information describes the signs and symptoms of a concussion. Please read and acknowledge that you have read the "Concussion Fact Sheet for Coaches" by clicking on the link below and answering the subsequent questions.

Concussion Fact Sheet

Yes. I have read and understand what a Concussion is

How to recognize a Concussion?:* Wisconsin State Law (WI Act 172, Statue 118.293) requires all youth athletic organizations to educate coaches on the risks of concussions and head injuries . The following information describes the signs and symptoms of a concussion. Please read and acknowledge that you have read the "Concussion Fact Sheet for Coaches" by clicking on the link below and answering the subsequent questions.

Concussion Fact Sheet

Yes. I have read and understand the common signs, symptoms , and behaviors of a possible concussion.

How to prevent a Concussion?:* Wisconsin State Law (WI Act 172, Statue 118.293) requires all youth athletic organizations to educate coaches on the risks of concussions and head injuries . The following information describes the signs and symptoms of a concussion. Please read and acknowledge that you have read the "Concussion Fact Sheet for Coaches" by clicking on the link below and answering the subsequent questions.

Concussion Fact Sheet

Yes. I have read and understand how to help prevent a concussion. I agree to remove any athlete from play/practice if a concussion is suspected.

What to do if you suspect a Concussion?:* Wisconsin State Law (WI Act 172, Statue 118.293) requires all youth athletic organizations to educate coaches on the risks of concussions and head injuries . The following information describes the signs and symptoms of a concussion. Please read and acknowledge that you have read the "Concussion Fact Sheet for Coaches" by clicking on the link below and answering the subsequent questions.

Concussion Fact Sheet

Yes. I have read and understand what to do if I suspect a concussion. I understand that it is my responsibility to inform the parent/guardian if I suspect a player has a concussion.

Coach Application

Confirmation

For Parents

For Coaches

For Officials

Coach Application

Confirmation