Saint Jude CYO COACHING APPLICATION

Thank you for volunteering to be a coach for the St. Jude CYO Program. Please complete this application in its entirety and email to

Completing an application does not guarantee a coaching position. All applications will be accepted and reviewed by the CYO Athletic Director and personal interviews may also be requested.

Name ______

Address ______

Home Phone ______Cell Phone ______

E‐mail ______

Date of Birth ______

Sport ______

Please Select:

Head Coach Assistant Coach Other

Boys Girls Co‐Ed

Varsity JV4th Grade

Experience ______

As a coach of St Jude CYO Program, I accept the responsibility for the actions of my athletes, coaching staff and spectators. Additionally, I am familiar with the rules and guidelines pertaining to the sport for which I coach outlined in the most recently published CYO Athletic Ministry Handbook. I am aware that all coaches must fill out this form to participate in this program, and that all coaches (head & assistants) must attend the CYO Coaches’ Orientation Program prior to their second year of coaching the above named sport.

I testify that the information above is correct and I accept all of the terms above:

Coach’s Signature: ______Date: ______

All CYO coaches must have their clearance forms and other documentation on file with the parish as required by the Archdiocese of Philadelphia. Upon receipt of your completed coaching application, Ted Dufner, St Jude CYO Athletic Director, will work with you to confirm that the following documentation is on file with the parish:

  • Certificate of Proof of attendance at Protecting God’s Children / Safe Environment Seminar (need to attend seminar only once)
  • Information & Communication Technology Addendum Certification (needs to be submitted only once IF you attended the PGC / SE Seminar PRIOR to June

2011; the I&CT Addendum is now covered in PGC / SE Seminars)

  • Certificate of Proof of Mandated Reporting of Suspected Child Abuse Online Training (needs to be submitted only once)
  • PA Department of Public Welfare Child Abuse Clearance Check (must be renewed every 5 years)
  • PA State Police Criminal History Clearance Check (must be renewed every 5 years)

In addition, all CYO coaches must have the Coaching Accreditation Certification on file with the CYO Board

(Need to attend the Archdiocesan Coaches OrientationCourse session only once).

By having a complete coaching file on record, it keeps St Jude in compliance with the Archdiocese. Our failure to remain in compliance could jeopardize the St.Jude CYO Program. Thus, we appreciate your cooperation! Please contact Ted Dufner with any questions.

St.Jude CYO Board Use Only:

Year of Archdiocese Coaching Accreditation Course: ______PA Child Abuse Clearance Expiration Date: ______

PA Criminal History Clearance Expiration Date: ______Date attended PGC Seminar: ______

Date of I&CT Addendum Certification (if applicable): ______Date of Mandated Reporting Training: ______

I am familiar with the coach listed above. I am certain that they will conduct themselves in a Christian‐like manner. I am aware that all coaches (head & assistants) must attend the CYO Coaches’ Orientation Program prior to their second year of coaching this sport.

Pastor’s Signature: ______Date: ______

Version September 2014