Rutland Town Parks and Recreation
Coach / Volunteer Information Form
Last Name:_______________________________					First Name:____________________________________
Address:______________________________________________________________________________________
		(Street)			(City)		(State)		(Zip)
Age:_________			Date of Birth:________________					M/F:___________
Home Phone:______________________________						Cell Phone:___________________________
Work Phone:_______________________________						E-mail Address:__________________________
Place of Employment:________________________________						Position:________________________________
Sport/Activity of Interest:_____________________					Age/Grade Level of Interest:_______________________
Name of Participating Child. (If Applicable)				_________________________________________________________
Coaching: (Select one)
	Head Coach:		________			Book/Score Keeper		________
	Asst. Coach:		________			Adult. Asst.:		________
Please list/explain your experience related to your area of interest:_______________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Volunteers:
	Concessions:		________			Function Clean-up		________
	Officiating		________			Website Coord.		________
	Function Set-up		________
The success of this department and its programs relies heavily on the willingness of towns people to volunteer their time and expertise
to the youth of our community. Please understand that we appreciate any and all volunteer efforts, but at times, we may need to make
selections. These should in no way be taken personally or insinuate any lack of respect or appreciation.
_______________________________________________________________							Date:_________________________
(Signature )
Please return the completed form to Rutland Town Recreation or mail to the following address.
Rutland Town Offices
P.O. Box 225
Center Rutland, VT 05736