Western Loudoun Basketball (WLBL)
Coaches Registration
 NOTE: Remember to scroll down and click Submit Form when done!

Coaches Must be at least 18 years of age and have a valid drivers license!
General Information

Last Name

First Name

Address

City

State

Zip

Phone

Cell

eMail

 fully qualified ie: john.doe@aol.com

eMail

verification must be same as above

Birth Date

 mm/dd/yy

Gender

Grade

Choice

 order of preference

Travel

 7th & 8th only!

Experience
Background Screening Acknowledgment
WLBL reserves the right to do background screening on any coach for the protection of our youth.  The information collected on this form will not be shared with anyone outside the WLBL board of supervisors. By clinking yes below to the acknowledgement question you are indicating that you are aware of WLBL's option to run a background check on coaches.

Acknowledge ?

Permit #

Convicted ?

Details

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