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2. Do you want to Coach or Referee?*
   -- Select One --CoachReferee
3. Have you Coached or Refereed before?*

   1. Yes
   2. No
5. What sport(s) do you want to coach/ref?*
   -- Select One --T-BallBaseballSoftballFlag FootballKickballSoccerVolleyball
6. Do you have an Assistant Coach?*

   1. Yes
   2. No

   If YES, please complete the Assistant Coach information section below.

8. Do you have a child(ren) playing in Jacksonville sports?*

   1. Yes
   2. No
12. Head Coach First & Last Name:*
14. Phone #:*
15. Email:*
17. Street Address:*
18. City, Zip, State*
22. Assistant Coach First & Last Name:*
24. Phone #:*
25. Email:*
27. Street Address:*
28. City, Zip, State*
32. Liability Release:

    My signature confirms that I hereby release and forever discharge the Jacksonville Parks & Recreation Department, the City of Jacksonville, and their employees from any and all manner of claims, causes of action, or liability, which may exist or may exist at any time in the future, arising out of or pertaining to any injury, loss, damage, or harm of any kind which has, will or may result or occur while participating in this program. 

34. Waiver Agreement:*
    -- Select One --YesNo
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field