EmailMe Form - Coach/Assistant Certification

Volunteer Applicant Name *

First Last

Email *

Confirm

Please select the coach certification course you completed: *

Attended Hillsborough County Classroom course

Completed NAYS online course

Course Title: *

Date of Completion: *

MM / DD / YYYY

Enter NAYS Membership #: *

NAYS Membership Expiry Date:

MM / DD / YYYY

Membership expires after one year unless you paid for multiple years.

Concussion Training completed: *

YES

NO

Proof of completion must be provided to WSA by the deadline for the upcoming season. If you are a returning coach or completed concussion training for another organization or as a job requirement (e.g. physician, etc.), you do not need to complete it again. If you are new WSA Coach/Assistant, proof will be required.

Please select the mandatory Concussion Training completed: *

Included with NAYS certification

CDC online certification (Certificate must be uploaded)

Other (Please specify):

Concussion training is a mandatory requirement: *

I will complete the mandatory CDC Concussion training and submit proof of completion by the deadline.

Proof of completion must be provided to WSA by the deadline for the upcoming season. If you are a returning coach or completed concussion training for another organization or as a job requirement (e.g. physician, etc.), you do not need to complete it again.

First Aid Training completed/valid: *

YES

NO

Proof of completion must be provided to WSA by the deadline for the upcoming season. If you are a returning coach or completed concussion training for another organization or as a job requirement (e.g. physician, etc.), you do not need to complete it again unless it has expired.

**First Aid & CPR training is valid for 2 years.**

First Aid training is a mandatory requirement: *

I will complete the mandatory First Aid training and submit proof of completion by the deadline.

Proof of completion must be provided to WSA by the deadline for the upcoming season. If you are a returning coach or completed concussion training for another organization or as a job requirement (e.g. physician, etc.), you do not need to complete it again unless it has expired.

**First Aid & CPR training is valid for 2 years.**

CPR Training completed/valid: *

YES

NO

Proof of completion must be provided to WSA by the deadline for the upcoming season. If you are a returning coach or completed concussion training for another organization or as a job requirement (e.g. physician, etc.), you do not need to complete it again unless it has expired.

**First Aid & CPR training is valid for 2 years.**

CPR training is a mandatory requirement: *

I will complete the mandatory CPR training and submit proof of completion by the deadline.

Proof of completion must be provided to WSA by the deadline for the upcoming season. If you are a returning coach or completed concussion training for another organization or as a job requirement (e.g. physician, etc.), you do not need to complete it again unless it has expired.

**First Aid & CPR training is valid for 2 years.**

Upload First Aid, CPR, Concussion certificates:

Please use this field to upload First Aid, CPR (and concussion certificate if you did not complete during the NAYS course or County course).

YOUR Jersey Size

AS

AM

AL

AXL

2XL

If you didn't include your Jersey Size on your Volunteer Application or would like to change it, please enter it here. We do not order extras so please make sure to size yourself using the samples available during the Registration opportunities.

Comments/Additional Info: (Optional)