Basketball Coaches Without Boundaries

Thomas Johnson Middle School Mid-Maryland

Basketball Program

Make the Right Move—Stay In School

Where Family and Education Come First !

A new Generation of Coaches for the next Generation of Student Athletes

VOLUNTEER IN YOUTH SPORTS

Mid-Maryland Basketball Program

TJMS Basketball Team Coach

Consent/Release Form

Name of Organization: Basketball Coaches Without Boundaries, Inc  

Recreation Council  Year:  2013 - 2014 

Head Coach                      

Jr. Division            

Team Name:

Full Legal Name:  ___________________________________________________________

Date of Birth: _____/_____/_____            Social Security Number: May be required if background check done

Address

Street:______________________________________________________________________

City__________________________          State__________                    Zip______________

Telephone/Cell #   __________________________ 

I, the undersigned, by execution of this document, give Basketball Coaches Without Boundaries, Inc permission to conduct a background check if necessary regarding my qualifications to coach in the 2013 BCWBRC/TJMS Mid-Maryland Basketball  Program.

I understand that I have a right to: (1) obtain a copy of my background check report if BCWB finds it necessary to do a background check (2) challenge the accuracy of any information contained in this report by contacting the third party responsible for conducting the background check by calling the telephone number listed on the report.

By signing this application, I agree to the following:

  I certify that I have not been convicted and do not have any charges currently pending against me for any of the following disqualifying crimes found.

          

·        I agree that at all times while servicing as a volunteer coach for Basketball Coaches Without Boundaries, Inc. I will immediately notify the BCWB organization if I am charged with any of the disqualifying crimes. 

Print Name:                                                                                                                                                                                                 Date:                                                                                                    

Signature: