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2. First Name*
3. Last Name*
5. Street Address*
   Include apartment number or suite if it applies
7. City*
8. State*
9. Zip Code*
11. Email Address*
13. Phone
14. Age*
16. Best Time of Day to Call
17. Coaching Shirt Size
19. Indicate sport choices that interest you.*

    Check all that apply.

    1. Basketball: Ages 5-6
    2. Basketball: Ages 7-8
    3. Boys Basketball: Ages 9-12
    4. Girls Basketball: Ages 9-12
    5. Baseball: Ages 7-9 (Machine Pitch)
    6. Baseball: Ages 10-12

    1. Indoor Soccer: Ages 4-5
    2. Indoor Soccer: Ages 6-8
    3. Soccer: Ages 4-6
    4. Soccer: Ages 7-8
    5. Soccer: Ages 9-10
    6. Soccer: Ages 11-12

    1. Tee Ball: Ages 4-5
    2. Tee Ball: Ages 6-7
    3. Volleyball: Ages 8-11
    4. Flag Football: Ages 5-7
    5. Flag Football: Ages 7-9
21. Background Form Submission
    Complete Background Form Here

    Please complete the following information, which will then be submitted to the Pueblo West Metro Human Resources Department.  The HR department will then contact you via email to complete the online background check process. 

23. NAYS Concussion Course Link
    Complete Course Here

    complete the free concussion course and upload certificate in browse below

25. Upload Your National Alliance for Youth Sports Concussion Certificate in PDF Format*
27. Coaching Guidelines
    Coaching Guidelines

    Please read and sign the volunteer coaching guidelines

29. Coaches Code of Conduct
    Coaches Code of Conduct

    Please read and sign the coaches code of conduct

31. Thank you for submitting an application to become a volunteer coach for Pueblo West Parks and Recreation.  You will be notified by the Parks and Recreation department via email or phone call if your application is accepted and approved to volunteer coach in a youth sports league.

33. Comments
    Please let us know if you have any additional important information we need to know about.
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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field