American Coaches Association
Application

After completing this form and submitting payment (step 1), you will be given directions for your background check (step 2).

First Name - Use your legal name. *

Middle Name (put NMN if you have no middle name)

Last Name *

Mailing address

Address Line 2

City *

State *

Zip Code *

Phone Number *

EMAIL ADDRESS: Use the Coach's email address - All contact is through email. If this is incorrect, nothing will go through. Check your spam folder for emails. *

Team Name - US Amateur Basketball Team Name *

Team Gender *

Girls

Boys

Team ID Number 🛈

Team Grade - Enter only 1 grade even if you are associated with more than 1 team. *

It is my understanding that the American Coaches Association, Inc. (ACA) will conduct a public record search of my personal criminal history.

I hereby authorize an officer or employee of ACA or any other authorized representative of ACA bearing this release or a copy of this release, within one year of its date, to obtain information in your files pertaining to personal history.

I hereby release ACA from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization and request to release information.

In connection with my application for employment or to serve as a volunteer with American Coaches Association, Inc., I understand that a “consumer report” and/or “investigative consumer report”, as defined by the Fair Credit Reporting Act, will be requested by Client for employment or volunteer purposes.

I hearby release ACA and the agency contracted to perform the background check from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization and request to release information. By agreeing and submitting this form, I hereby verify that the information is mine and is true and correct. *

Agree

Disagree

I hearby acknowledge I have watched the concussion video and am aware of the nature and risk of concussion and head injury. I will also have each parent or guardian sign and return an informed consent that explains the nature and risk of concussion and head injury, including the risk of continuing to play after concussion or head injury. Athletes who are suspected of sustaining a concussion or head injury in a practice or competition will be immediately removed from activity. An athlete who has been removed from an activity may not return to practice or competition until they submits to the athletic coach a written medical clearance to return stating that the athlete no longer exhibits signs, symptoms, or behaviors consistent with a concussion or other head injury. Medical clearance must be authorized by the appropriate health care practitioner. *

Agree

Disagree

Please enter your signature if you agree to the above release & waivers *

Annual Application Fee. To have your credit card go through, enter the name and address as it appears on the credit card statement to complete payment. (This address may be different than the address above. This is the billing address for your credit card.) *

Annual Application Fee $30.00

Annual Application Fee. To have your credit card go through, enter the name and address as it appears on the credit card statement to complete payment. (This address may be different than the address above. This is the billing address for your credit card.) *

Annual Application Fee $30

American Coaches Association Application

American Coaches Association
Application