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Coaches and Volunteers

Coach Application

Thank you for your interest in coaching with Lighthouse Soccer Club. Please complete, sign, and submit the form below to send us your coach application. We'll be in touch shortly. Information sent through this form is protected with 256-bit SSL encryption.

Your Name*
First Last
Your Social Security Number*
Required for EPYSA Risk Management Application
Your Home Address*
Street Address Address Line 2 City State ZIP Code
Your Primary Phone Number*
Your Secondary Phone Number*
Your Email*
Your Gender*
- Female
- Male
What Age Group Would You Llke To Coach?
What Program Would You Like To Coach?*
Please check all that apply.
- Boys Travel
- Girls Travel
- In-House Program
- TOPSoccer
Do You Have Any Medical Conditions?*
- No
- Yes
Please List Your Medical Condition(s):*
Do You Have Experience Playing Soccer?*
- No
- Yes
Please List Your Playing Experince:*
Please detail Where, When, What Position, and at What Level
Do You Have Experience Coaching Soccer?*
- No
- Yes
Please List Your Coaching Experience:*
Please list detail Where, When, and at What Level
Do You Have Any Coaching Licenses or Certifications?*
- No
- Yes
Please List Your Coaching Licenses or Certifications:*
Please detail Where, When, and at What Level
Confirmation*
- I agree under penalty of law that the above information is true and accurate to the best of my knowledge.
Signature
Please use your mouse (or finger on a touchscreen device) to sign this form.

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PO Box 11562, Philadelaphia, PA 19116

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