Name
Home Address
Position applying for
Grades/Genders applying for
List your coaching experience within the last five years. Work from the highest level (competitive) first back to house league play (not in chronological order).
· Playing Experience: List your basketball playing experience (from highest level first) noting specific awards or certifications received as a overall assessment of your basketball knowledge Sport: Age Level Dates (From/To) Comments, Results, Awards, Certifications.
Have you ever been ejected from a game and/or served a suspension as a result of your actions as a coach, assistant coach or spectator (in any sport)? If yes, please provide details
Please provide the name, telephone number and e-mail address of two references who are familiar with your basketball work.
  • I have read, understand and agree to abide by all of the South Loudoun Basketball League rules and Codes of Conduct as stated on the league’s web site, www.solohoops.com.
  • I also understand that these rules may be modified during the course of the season and that it is my responsibility to remain informed about league rules and proceedings.
  • I understand that I may be suspended or removed from my coaching position by the Commissioner for violations of the League Rules and/or Codes of Conduct.
  • I hereby release and waiver all claims against Loudoun County Department of Parks, Recreation and Community Service, the South Loudoun Basketball, coaches, volunteers and sponsors in regard to the listing of coaches information (name, email and cell phone) on the South Loudoun Basketball web site
  • I state that I have never been charged, arrested or convicted for any crime of violence and/or abuse against children and/or persons, or one that would affect my ability to coach a team within South Loudoun Basketball.
  • I give permission to South Loudoun Basketball  to conduct a background check on me which may include a review of criminal and child abuse records maintained by governmental and/or law enforcement organizations.
  • I understand that the South Loudoun Basketball Board approves all requests to coach
  • I have read and understood all above acknowledgements.