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5.) Previous Coaching Experience
Have you ever coached a sports
team?____No ____ Yes
If
yes, please list
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Organization |
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6.) References (minimum 2 references)
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St.
Clement Athletic Committee Responsibilities
All members will be expected to:
-
Help develop and
maintain a program that promotes for as many Parish
children as possible, a variety of age appropriate sporting experiences
that provide a fun, self-esteem building environment where sport (s)
fundamentals, sportsmanship and other life skills are taught and reinforced
which are consistent with the teachings of the St. Clement Catholic community.
-
Perform the
necessary oversight of all SCAC activities.
-
Make a concerted
effort to attend and participate in all committee meetings.
-
Actively volunteer
for various board activities.
-
Become
knowledgeable of and follow all appropriate Diocese, Parish and Committee rules,
policies, guidelines and regulations to the best of their ability.
-
Maintain
appropriate communication channels with other board members, various league
constituencies, coaches, parents and players.
I
hereby certify that I have not been convicted in New Jersey or any other state
or jurisdiction of any crime or disorderly persons offense involving sexual
offenses, child molestation, DWI, endangering the welfare of children or
incompetents, arson, armed robbery, aggravated assault, kidnapping, murder,
manslaughter or violations of the New Jersey Controlled Dangerous Substance Act.
I
have read, understand, and will abide by all of the above if selected as a
S.C.A.C. board member. I certify
that all of the information provided above is true.
Applicant
Signature_________________________________________
Date
___________________________
04/02
ADDENDUM #3
Board Member and Term Expiration
Board Member
Date First Appointed
Date Current Term Began
Date Term Expires
Father John
Scully , Pastor
Mrs.
Margaret Corcoran, CCD Director
Mr. James
Gallagher, Athletic Director
Mr. John MacLane,
Assistant Athletic Director
Mr. Christopher Kirby, Intramural Coordinator, Fund Raising
Mrs. Phyllis J. Besso, Treasurer
Mrs. Judy Hart, Secretary
Mr. James Besso ADDENDUM
#4 Click
here for the 2007-2008 Registration Package for Basketball and Cheerleading ADDENDUM
#5
DIOCESE OF TRENTON ELEMENTARY SCHOOL SPORTS PHYSICAL FORM GRADES K-8 Student’s
Name_______________________
Date of Birth____________ Grade____________
Male______Female_______ EXAMINATION:
Height______
Weight_______
B/P______________
Hearing___________
Vision_________ Heart______
Lungs________
Abdomen__________ Hernia_______
LymphNodes__________
Thyroid____________ Scoliosis________
Genito-Urinary_________ Skin_________ Orthopedic________
Feet____________
Nose_________ Throat_________
Mouth/Teeth__________
Nervous System___________ Comments___________________________________________________________ MEDICATIONS
PRESENTLY PRESCRIBED_______________________________ ALLERGIES:___________________________________________________________ TREATMENT:__________________________________________________________ HISTORY
OF: Asthma______
Allergies____
Heart Problems_______ Fractures_____
Eye Problems______
Diabetes__________ Hypoglycemia________
Headaches________
Nose Bleeds________ Congenital
Defects_______
Operations_______________ Injuries______________
Drug Sensitivities_____________________________ Drug
Sensitivities___________________
Other Health Problems_________________ Comments_______________________________________________________________ PHYSICIAN’S
FINDINGS PERTINENT TO PARTICIPATION IN ATHLETIC ACTIVITIES:
Full Participation Allowed_______________
Limited Participation Allowed______________
No Participation Allowed__________________
Restriction on Activity_____________________
Physician’s Name and
Address_______________________________________________________
Physician’s Signature__________________________Date of
Physical______________________ RETURN TO: SCHOOL NURSE’S OFFICE ADDENDUM
# 6 DIOCESE OF TRENTON Medical Treatment Authorization Form As
parent and /or guardian of______________________________________, a minor, I
hereby authorize the treatment by a qualified and licensed medical doctor in the
event of a medical emergency which, in the opinion of the attending physician,
may endanger my child’s life, cause disfigurement, physical impairment or
undue discomfort if delayed. This
authority is granted only after a reasonable effort has been made to reach me.
I further authorize that my child may be transported to a hospital or
emergency clinic for treatment.
Name of Parent/Guardian_________________________________________________
Address___________________________________________________
City__________________________State_______Zip_____________
Daytime phone # (_____)________________________
Evening phone # (_____)________________________
Family Physician_________________________Phone______________
Date during which release is granted:
From____________To_________ Indicate specific medical
allergies, chronic illnesses, or other medical conditions that coaches and
medical personnel should be aware of: __________________
________________________________________________________________________________________________________________________________
Other person to contact in case of emergency:______________________
Relationship to child_____________________________
Daytime phone # (_____)__________________
Evening phone # (_____)__________________ This release form is completed and signed of my own
free will for the sole purpose of authorizing medical treatment under emergency
circumstances in my absence. Signature___________________________Notarized
by___________________ Date________________________ ADDENDUM
#7 Please
Detach and Return to St. Clement Athletic Association:
Date ____________________ ADDENDUM
#8 St. Clement
Parish Athletic Committee -
Parent/Guardian/Athlete Code of Conduct - The purpose of the St. Clement Parish Athletic program is to
provide a fun, instructive and positive sporting environment where children can
learn sportsmanship and the fundamentals of a sport(s) along with other life
skills that are consistent with the teachings of the St. Clement Catholic
community. One of the main tenets of the program is to support and
reinforce the spiritual formulation of each participant according to Catholic
faith principles. This entails
what it means to be a member and a spiritual ambassador of the St. Clement
Catholic community which includes following and promoting certain faith based
responsibilities such as weekly Mass attendance, frequent participation in the
sacraments, performing meaningful prayer on a consistent basis and respect for
all forms of life. As a member of the St. Clement Athletic Program either as a
student-athlete and/or parent/guardian, you are expected to exhibit the
appropriate behavior given each circumstance that you may encounter as a
representative of the St. Clement community.
1.
The Committee expects all St. Clement coaches, team members,
parents, family, friends and associates to always
be in control of their conduct/emotions. 2.
To conduct themselves in a professional and appropriate manner as
they represent the teachings and beliefs of the St. Clement Catholic community. 3.
One of the main goals of the St. Clement Athletic Program is to
teach the participants not only how to play a sport, but also how to exhibit a
high degree of sportsmanship. We
expect all of our coaches, volunteers, parents and student-athletes to set and
reinforce these ideals both on and off the field. 4.
Other than communication of encouragement and support, the
Committee feels that at no time should parents or student-athletes engage in
communications with any player, coach, parent or fans of either team or any game
officials during the contest. Should
a parent/guardian or student-athlete feel a need to express a concern or
instruction, that communication must be funneled through the appropriate St.
Clement coach. 5.
Under no circumstances should a parent/guardian or student-athlete
engage in any verbal abuse or acts of intimidation with a player, coach or game
official. Rather, if the person is a
recipient of the same, that fact should be brought to the attention of the St.
Clement Coaching staff for proper handling. 6.
The decisions of all game officials are final and should be
implemented as instructed and in the proper spirit. At no time is a
parent/guardian or student-athlete to engage an official before, during or after
a contest to protest a call or situation. Again,
any concerns must be funneled through the St. Clement Coaching staff. 7.
At each team activity, it is everyone’s responsibility to make
every effort to ensure that safety is considered a priority and secured. 8.
A parent/guardian or student-athlete should first report any
observed behavior that is inconsistent with this policy to the appropriate St.
Clement Coach. If the situation is
not addressed properly, notice should then be made to the St. Clement
Athletic Board. 9.
If our code of conduct rules are violated. Parent/guardian or
athlete or coach are held accountable by SCAC. First time is a warning, unless
SCAC feels no warning should be given. In this case The person who violates the
Code of Conduct is dismissed from our program upon SCAC discretion. The second
violation is dismissal, upon SCAC discretion 10.
If a parent/coach has an issue with somebody in our Parish due to a
heated argument, this argument must stop and a minimum of 24 hour cooling off
period before parties may meet. SCAC Board member must be at meeting.
ADDENDUM
#9 DIOCESAN
ATHLETIC PROGRAM
REQUIREMENTS v
Publish
and distribute a Sports Handbook to each child participating in the program.
·
Completion
of Rutgers S.A.F.E.T.Y. Clinic ·
Attendance
at Fall Conference ·
Criminal
Background Check in accordance with Diocesan Policy ·
Coaches
registration form on file v
With the
EXCEPTION of Cross Country and Track events no event or practice may begin prior
to Noon on Sundays
ADDENDUM #10 OFF SEASON USE
OF FACILITIES BY SCAA MEMBERS The Facilities will only be available for use by St.
Clement Athletic Association and Members Off season:
Generally considered to be the time in which NMPBL
basketball games are not being played. (April – September) St. Clement Coaches:
Are coaches who are registered in the preceding season. Coaches must be
Rutgers certified, Virtus certified and
fingerprinted and must agree to the policies and procedures and code of conduct
of the St. Clement Athletic Association. Supervision:
A St. Clement Athletic Association Board member or coach in good standing must
be present at all times and with keys to open the gym and lock up afterward and
are responsible for compliance with the rules and by-laws. Keys can only be
handled by St. Clement Board Member or Representative (such as a St. Clemet
Coach in good standing). Payment:
Payment is required in advance to cover taking
down of tables (usually Friday) and setting up (usually Wednesday) Scrimmage:
Only allowed for games involving at least one St.
Clement Coached Teams. St. Clement Coach is responsible for the gym, insurance
for both teams and cleaning up and locking up. Responsibility:
St. Clement Coach is responsible for cleaning of the floor, keeping the bathroom
clean, keeping the foyer clean, keep players and children off the stage,
cleaning of the gym after the practice or game, Proper use of AC or heat, and
turning off of lights and locking up gym after practice or scrimmage. Insurance:
Coaches are responsible for their own insurance.
St. Clement Coach must check that a visiting coach and has proper credentials
(Rutgers License and Virtus) and has their own insurance Subject to Availability:
Subject to the schedule of St. Clement
Athletic Association activities or St. Clement CCD activities receive priority.
ST. CLEMENT'S ATHLETIC ASSOCIATION
172 Freneau Avenue – Matawan, NJ
07747
www.stclementsports.com Registration Form for teams
using St. Clement Gym in during off season in accordance with SCAA by-laws. See
www.StClementSports.com.
YEAR:_____________________________________________________
Name:_________________________________________________________________
Address:________________________________________________________________ City: State:
Zip:___________ Home Phone:
Cell
Phone:_____________________________ E-mail Address:_________________________________ Date of
Birth:___________________ Date of Birth:________________________
Grade:________________________ Sibling(s) in
program:________________________ Grade(s):_________________ Name of Supervising Coach(s)
(must be St. Clement Coach who will be on premises):
MEDICAL HISTORY: ***Any SPECIAL medical condition or need that our staff
should be aware of for your child? ______Yes _____No If YES, please
describe:__________________________________________________________
_____________________________________________________________________________
Physician Name: Phone Number:
__________________ Medical
Insurance Compa Policy #:
___________________
AGREEMENT TO PARTICIPATE IN
A SPORT BY THE ATHLETE I
have complied with all eligibility requirements and have obtained the necessary
insurance. I will strive to always exhibit a high level of sportsmanship and
respect for coaches, teammates, officials and opposing teams consistent with the
beliefs and teachings of the St. Clement Catholic community while a member of
the team. I understand that I am responsible for all equipment issued to me,
that I will pay for any equipment that is abused, lost stolen or misplaced and
will return it when required. I
fully understand the risk of physical injury associated with competitive sports
and appreciate the consequences of these risks. I know the importance of
following directions and will do my best to adhere to all league, team and game
rules both in competition and during practice. I will make a reasonable attempt
to attend all practices and games while making every effort to arrive and be
picked -up on time. I
fully understand the above risks and responsibilities and agree to participate
in the St. Clement Athletic Program. PARENTAL RELEASE I
give the child listed on this application permission to participate in the
indicated sports and engage in interscholastic athletics. I understand that my
son/daughter is responsible for all equipment and will pay for all items
abused, lost, stolen or misplaced. I
fully understand the possibility of physical injury associated with competitive
sports and hereby release, discharge , and/or otherwise indemnify St. Clement
Parish, its affiliated organizations and sponsors, their employees and
associated personnel against any claim on behalf of the athlete as a result of
the athlete's participation in the St. Clement Athletic Committee programs or
activity and/or transportation to or from the same. I understand that I am
responsible for making sure that my son/daughter arrives and is picked-up on
time for all practices and games. CODE OF CONDUCT SCAC
strongly feels it is important that all athletes, coaches, volunteers, parents,
guardians, and family members conduct themselves appropriately at all SCAC-
sanction ed events. Associated with this application is a CODE of CONDUCT
that outlines those behavioral requirements. Application to play a SCAC-sponsored
sport acknowledges reading, understanding and agreeing to abide by the Code of
Conduct at all times.
Parent Signature:
Date:____________________
*******APPLICANTS MUST BE A
ST. CLEMENT'S PARISHONER AND ATTENDING THE ST. CLEMENT'S CCD
PROGRAM.************************
ST. CLEMENT'S ATHLETIC ASSOCIATION
172 Freneau Avenue – Matawan, NJ
07747
www.stclementsports.com Registration Form for teams
using St. Clement Gym in during off season in accordance with SCAA by-laws. See
www.StClementSports.com.
YEAR:_____________________________________________________
Name:_________________________________________________________________
Address:________________________________________________________________ City: State:
Zip:___________ Home Phone:
Cell
Phone:_____________________________ E-mail Address:_________________________________ Date of
Birth:___________________ Date of Birth:________________________
Grade:________________________ Sibling(s) in
program:________________________ Grade(s):_________________ Name of Supervising Coach(s)
(must be St. Clement Coach who will be on premises):
MEDICAL HISTORY: ***Any SPECIAL medical condition or need that our staff
should be aware of for your child? ______Yes _____No If YES, please
describe:__________________________________________________________
_____________________________________________________________________________
Physician Name: Phone Number:
__________________ Medical
Insurance Compa Policy #:
___________________
AGREEMENT TO PARTICIPATE IN
A SPORT BY THE ATHLETE I
have complied with all eligibility requirements and have obtained the necessary
insurance. I will strive to always exhibit a high level of sportsmanship and
respect for coaches, teammates, officials and opposing teams consistent with the
beliefs and teachings of the St. Clement Catholic community while a member of
the team. I understand that I am responsible for all equipment issued to me,
that I will pay for any equipment that is abused, lost stolen or misplaced and
will return it when required. I
fully understand the risk of physical injury associated with competitive sports
and appreciate the consequences of these risks. I know the importance of
following directions and will do my best to adhere to all league, team and game
rules both in competition and during practice. I will make a reasonable attempt
to attend all practices and games while making every effort to arrive and be
picked -up on time. I
fully understand the above risks and responsibilities and agree to participate
in the St. Clement Athletic Program. PARENTAL RELEASE I
give the child listed on this application permission to participate in the
indicated sports and engage in interscholastic athletics. I understand that my
son/daughter is responsible for all equipment and will pay for all items
abused, lost, stolen or misplaced. I
fully understand the possibility of physical injury associated with competitive
sports and hereby release, discharge , and/or otherwise indemnify St. Clement
Parish, its affiliated organizations and sponsors, their employees and
associated personnel against any claim on behalf of the athlete as a result of
the athlete's participation in the St. Clement Athletic Committee programs or
activity and/or transportation to or from the same. I understand that I am
responsible for making sure that my son/daughter arrives and is picked-up on
time for all practices and games. CODE OF CONDUCT SCAC
strongly feels it is important that all athletes, coaches, volunteers, parents,
guardians, and family members conduct themselves appropriately at all SCAC-
sanction ed events. Associated with this application is a CODE of CONDUCT
that outlines those behavioral requirements. Application to play a SCAC-sponsored
sport acknowledges reading, understanding and agreeing to abide by the Code of
Conduct at all times.
Parent Signature:
Date:____________________
*******APPLICANTS MUST BE A
ST. CLEMENT'S PARISHONER AND ATTENDING THE ST. CLEMENT'S CCD
PROGRAM.************************ RECOGNITION OF TEAM ACCOMPLISHMENTS WITH BANNERS,
T-SHIRTS, JACKETS AND PLAQUES Recognition:
SCAA will recognize team accomplishments of
teams attaining a NMPBL recognized championship Banners:
Banners will be purchased and displayed in the
gym for teams attaining a NMPBL recognized championship. Where the league has
separate divisions, the banner will contain the name of the division for which
the championship was earned. The banner will contain the names of all the
players on the roster during the playoffs plus the head coach and assistant
coaches. There will be no exceptions to this rule. Jackets:
For NMPBL League Champions considered best division in the leagues age group,
Championship Jackets will be awarded. Below are the league divisions that
qualify for a championship jackets
1.
Boys - 5th/6th Grade Division NMPBL Recognized
League Champions highest division
2.
Girls - 5th/6th Grade Division NMPBL Recognized
League Champions highest division
3.
Boys - 7th/8th
Grade Division NMPBL Recognized League Champions highest division
4.
Girls - 7th/8th
Grade Division NMPBL Recognized League Champions highest division Color
and Style: Colors and style will be identical to all the other banners currently
hanging in the gym T-Shirts:
Championship teams will be awarded
t-shirts with the championship earned displayed on the front of the shirt.
T-Shirts will also be distributed to a
team who finishes in first place during the regular season. (A team that
finishes first in the regular season will be entitled to a t-shirt based on the
first place finish whether or not they win an NMPBL championship. If after the
playoffs they are also NMPBL champion, they will be entitled to a banner within
the rules captioned “Banner”. T-Shirts
can be awarded for other team accomplishments
as the board sees fit.
Participation
Awards: Participation awards will be distributed at the season ending “Year End
Party” which normally occurs in March. St. Clement logo gifts have been
distributed in the past such as:
1.
Blanket
2.
Beach Towel
3.
Equipment Bag Plaques:
The board of
directors may award plaques to be displayed in the gym in recognition for
significant contributions to the athletic association as the board sees fit.
Examples include:
1.
Coach in good standing with a ten year tenure
2.
Board member in good standing with a ten year tenure
3.
Persons serving on both the board and coaching staff with a ten year
combined tenure between both positions. If a board member was also a team mom,
this can also be considered when included as part of their service.
4.
SCAA members who the board deems made significant contributions to the
program
5.
NMPBL members who the board deems made significant contributions to the
program Plaque should say “St. Clement Athletic Association wishes to thank - In
Recognition of __ years of exceptional coaching – this award is to recognize the
accomplishments of Coach________ “; or “St. Clement Athletic Association wishes
to thank - In Recognition of __ years of exceptional contributions to the
program – this award is to recognize the accomplishments of (Title) of the St.
Clement Board of Directors (Name)“ A board member can be honored with a plaque by majority vote of the
executive committee or the board of directors.
Mr. Gil Carmichael
Mrs. Margaret MacLane
Mr. Robert McCloskey
Mr. Peter Pabon
Mrs. Donna Rean
Mr. Stephen Tomkins

ST. CLEMENT’S ATHLETIC
ASSOCIATION
172 FRENEAU AVE
MATAWAN, N.J. 07747
Notification
Notification must be made to the responsible board
member and be added to the official SCAA Calendar.
http://my.calendars.net/scaa/
Charge: Coaches
are only responsible to contribute to the fund to set up and take down bingo
tables and protective floor covering.
Bond:
NONE
Roster:
St. Clement
Coach in charge should submit a roster including
players and coaches names, addresses, phone numbers and coach application (coach
application should already be on file for St. Clement Coaches in good
standing). File should be maintained of all players and coaches (including home
and visiting teams) on facility with emergency information and health insurance
information for all players using the gym. Forms must be updated at least every
6 months and are available on below and at
www.StClementSports.com.
Board Approval:
All reservations must meet the above requirements
and then are subject to Board of Director’s approval.
Termination:
It must be understood that St. Clement Athletic
Association is not obligated to provide gym time to any team or individual.
Send mail to sports@StClementSports.com
with
questions or comments about this web site.
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