Volunteer Coach : Our Sports : Sports : Terre Haute Boys & Girls Club

Name

First Name *

Middle *

Last Name *

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Phone (Required)

Date of Birth (month/day/year) (Required)

SS# (Required)

Email (required) (Required)

Employer (required) (Required)

Have you ever been a coach at the Terre Haute Boys & Girls Club?

Have you ever been convicted of a felony or misdemeanor?

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If yes, please describe

Please choose the sport you would like to coach

Please choose the grade and/or gender you would like to coach

Electronic Signature (Required)

Date

Month

/

Day

/

Year

Email Address for Confirmation of Submission (Required)

Online Background Check Cost

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged