Hampton Soccer Club

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HOME > ABOUT > EXPENSE REIMBURSEMENT FORM

EXPENSE REIMBURSEMENT FORM

ALL EXPENSES SHOULD HAVE CLUB APPROVAL PRIOR TO EXPENSE INCURRSION

HSC REIMBURSEMENT FORM

* Indicates required field

Coach Candidate Name: *

First

Last

Coach Candidate Email: *

Coach Candidate Telephone Number: *

I am interested / willing to be... *

Head Coach Assistant Coach Either Head Coach or Assistant Coach

Which age group(s) are you interested in coaching? (select all that apply) *

u5/6 u7/8 u9/10 u11/12 u13/14 u15/16+ (u19)

Please provide 1 reference from your career experience and 1 personal (non-family member) reference

1 - Professional Reference Name: *

Reference 1 - Telephone Number: *

Reference 1 - Email Address: *

2 - Personal Reference Name: *

Reference 2 - Telephone Number: *

Reference 2 - Email Address: *

May we contact the references list above to discuss your experiences with them? *

Yes No

Have you ever been convicted of a felony? *

Yes No

I am aware of the Pennsylvania and PA West / Hampton Soccer Club Child Safety laws / requirements (State Police check, Dept Child Welfare check, PA residency affidavit or FBI fingerprint check and Safe Sport Certificate) *

Yes, I am aware and will complete all required if requested to do so by the Club

Please list any previous soccer and / or coaching experience (incl. any certifications / licenses): *

Comment *

Submit