2015-2016 Sport Club Coach Application

2015-2016 Sport Club Coach Application Coach Eligibility Each 2015-2016 Sport Club Coach Application will be reviewed and approved, deferred, or denied, by the Sport Clubs Advisor or representative. An individual is not an official coach until their application has been approved and they have submitted the following forms to Student Organizations & Leadership (University Union - 2nd Floor): HR Volunteer Identification Form Coach Contract & Agreement Form Copy of Driver's License Coach Information Contact Information - must be 10-15 digits long and may include only numbers, hyphens, and spaces. - name@myschool.edu First name: Middle initial: Last name: Email address: Phone number: Address: City: State: ZIP: Date of Birth MM/DD/YYYY Sac State ID# Complete if you are a Sacramento State student. - Numeric - ex: 1111 - must be between 9 and 9 characters. Years of Participation Please select the total number of years you have coached this club. - must select a value. [ ] New Coach [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ] 6 Are you interested in becoming a driver for your sport club? Becoming an approved driver is mandatory in order to drive yourself and/or others to and from competitions/events. [ ] Yes [ ] No Are you CPR and First Aid Certified? If you check yes, please bring copies of your valid CPR and First Aid cards to Student Organizations & Leadership (2nd floor of the University Union). Write your club name on the copy. [ ] Yes [ ] No Club Selection Page 1 of 9 2015-2016 Sport Club Coach Application

What sport club(s) are you applying for? [ ] Baseball [ ] Bass Fishing [ ] Cycling [ ] Gymnastics [ ] Men's Rowing [ ] Men's Rugby [ ] Men's Soccer [ ] Men's Volleyball [ ] Racquetball [ ] Rock Climbing [ ] Running [ ] Ski & Snowboard [ ] Tennis [ ] Triathlon [ ] Ultimate [ ] Wakeboard [ ] Women's Rugby [ ] Women's Soccer [ ] Women's Volleyball [ ] Wrestling Emergency Contact Information Emergency Contact Name Emergency Contact Phone Number - must be 10-15 digits long and may include only numbers, hyphens, and spaces. Emergency Contact Email Address - name@myschool.edu Your Relationship to the Emergency Contact Emergency Contact Notification I authorize Sacramento State and/or my club to notify my Emergency Contact in the case of an emergency. Adult vs. Minor Are you 18 years of age or older? If under 18 years of age, your parent/legal guardian must submit a paper copy of the release of liability (located in the files section) to the Student Organizations & Leadership Office. You will not be eligible to participate until this has been done. - must select a value. [ ] Yes, I am 18 years of age or older [ ] No, I am under 18 years of age Minor Information You have indicated that you are under the age of 18. For this reason, your parent/guardian must approve your participation in Sport Clubs. Please visit the below link to access the paper waiver and submit to Josh Mandel-Sonner (Sport Clubs Advisor) at Student Organizations & Leadership (2nd floor of University Union). https://orgsync.com/1983/files/804817/show Page 2 of 9 2015-2016 Sport Club Coach Application

YOU ARE NOT ELIGIBLE UNTIL YOUR APPLICATION HAS BEEN APPROVED (including submitting this document). 2015-2016 - RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activities & Hazards Activity: Participation in California State University, Sacramento's Sport Club program for the 2015-2016 academic year. The Sport Club program includes clubs for baseball, bass fishing, cycling, gymnastics, men's rowing, men's rugby, men's soccer, men's volleyball, racquetball, rock climbing, running, ski & snowboard, tennis, triathlon, ultimate, wakeboard, women's rugby, women's soccer, women's volleyball, and wrestling. Participation includes club meetings, practices, competitions, events, travel and fundraisers. Activity Date(s) and Time(s): effective August 31, 2015 - August 28, 2016 Activity Location/Facility: As dictated by published and announced schedules. Hazards to be aware of: Those associated with travel, practices and games. Hazard Mitigation: Practices and games: conditioning and techniques as directed by coaches and good practice; Travel: preparation and safe driving practices as recommended by University Risk Management. In consideration for being allowed to participate in this Activity, on behalf of myself and my next of kin, heirs and representatives, I release from all liability and promise not to sue the State of California, the Trustees of the California State University, California State University, Sacramento and their employees, officers, directors, volunteers and agents (collectively University ) from any and all claims, including claims of the University s negligence, resulting in any physical or psychological injury (including paralysis or death), illness, damages, or economic or emotional loss that I may suffer because of my participation in this Activity, including travel to, from and during the Activity. I am voluntarily participating in this Activity. I am aware of the risks associated with traveling to/from and participating in this Activity, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death. I understand that these injuries or outcomes may arise from my own or other s actions, inaction, or negligence; conditions related to travel; or the condition of the Activity locations(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to and from the Activity. I agree to hold the University harmless from any and all claims, including attorney s fees or damage to my personal property that may occur as a result of my participation in this Activity, including travel to, from and during the Activity. If the University incurs any of these types of expenses, I agree to reimburse the University. If I need medical treatment, I will be financially responsible for any costs incurred as a result of such treatment. I AM AWARE AND UNDERSTAND THAT I SHOULD CARRY MY OWN HEALTH INSURANCE. I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing the University from all liability, (b) promising not to sue the University, and (c) assuming all risks of participating in this Activity, including travel to, from and during the Activity. I understand that this document is written to be as broad and inclusive as legally permitted by the State of California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document have been made to me. [ ] I agree to the terms and conditions of the above waiver By entering my full name below, I am agreeing to the above release of liability, promise not to sue, assumption of risk and agreement to pay claims. August 1, 2015-August 30, 2015 - RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Page 3 of 9 2015-2016 Sport Club Coach Application

RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activities & Hazards Activity: Participation in California State University, Sacramento's Sport Club program for the 2015-2016 academic year. The Sport Club program includes clubs for baseball, bass fishing, cycling, gymnastics, men's rowing, men's rugby, men's soccer, men's volleyball, racquetball, rock climbing, running, ski & snowboard, tennis, triathlon, ultimate, wakeboard, women's soccer, women's volleyball, and wrestling. Participation includes club meetings, practices, competitions, events, travel and fundraisers. Activity Date(s) and Time(s): effective August 1, 2015 - August 30, 2015 Activity Location/Facility: As dictated by published and announced schedules. Hazards to be aware of: Those associated with travel, practices and games. Hazard Mitigation: Practices and games: conditioning and techniques as directed by coaches and good practice; Travel: preparation and safe driving practices as recommended by University Risk Management. In consideration for being allowed to participate in this Activity, on behalf of myself and my next of kin, heirs and representatives, I release from all liability and promise not to sue the State of California, the Trustees of the California State University, California State University, Sacramento and their employees, officers, directors, volunteers and agents (collectively University ) from any and all claims, including claims of the University s negligence, resulting in any physical or psychological injury (including paralysis or death), illness, damages, or economic or emotional loss that I may suffer because of my participation in this Activity, including travel to, from and during the Activity. I am voluntarily participating in this Activity. I am aware of the risks associated with traveling to/from and participating in this Activity, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death. I understand that these injuries or outcomes may arise from my own or other s actions, inaction, or negligence; conditions related to travel; or the condition of the Activity locations(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to and from the Activity. I agree to hold the University harmless from any and all claims, including attorney s fees or damage to my personal property that may occur as a result of my participation in this Activity, including travel to, from and during the Activity. If the University incurs any of these types of expenses, I agree to reimburse the University. If I need medical treatment, I will be financially responsible for any costs incurred as a result of such treatment. I AM AWARE AND UNDERSTAND THAT I SHOULD CARRY MY OWN HEALTH INSURANCE. I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing the University from all liability, (b) promising not to sue the University, and (c) assuming all risks of participating in this Activity, including travel to, from and during the Activity. I understand that this document is written to be as broad and inclusive as legally permitted by the State of California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document have been made to me. to the terms and conditions of the above waiver. By entering my full name below, I am agreeing to the above release of liability, promise not to sue, assumption of risk and agreement to pay claims. Health Insurance Information This section is for emergency contact information in case of personal injury or accident when under the auspices of Sacramento State Sport Clubs. All CLUB MEMBERS and COACHES are encouraged (but not required) to have primary health insurance. All members and coaches of a sport club participating in regularly scheduled practices and games will be covered under the CSU Club Sports Insurance Program. Under the terms of the coverage, Sacramento State's insurance is a SECONDARY CARRIER and its policy is accessed only in the event the student or student's primary insurance does not cover the entire bill. Exclusion or failure to provide accurate insurance information below, will result in the non-payment of medical bills received as a result of sport club participation, and may also result in expulsion from the team. Also, anytime alcohol or drugs are involved the CSU Club Sports Insurance is null and void. By entering my full name below, I acknowledge that I have read the above statement regarding health insurance coverage. - must contain at least 4 characters. Do you have Health Insurance? [ ] Yes [ ] No Primary Health Insurance Health Insurance Company Who is your medical provider (ex. Kaiser, Blue Cross of California, Blue Shield, Medi-Cal, etc.) Page 4 of 9 2015-2016 Sport Club Coach Application

Policy # This number typically appears on the front or back of your health insurance card (i.e. Kaiser card, Blue Cross card, Blue Shield card, Medi-Cal card, etc.) Policy Holder Name: Who is the policy holder? Your Relationship to the Insurance Policy Holder What is your relationship to the policy holder? Group # Health Insurance Company Phone Number - must be 10-15 digits long and may include only numbers, hyphens, and spaces. Health Insurance Information I verify that the health insurance information I provided is accurate, and agree to notify Student Organizations and Leadership if the status of my health insurance coverage changes, Health Insurance Information (cont.) Health Insurance Statement I verify that Sacramento State Sport Clubs has strongly recommended to me the value of having my own health insurance policy. Further, I understand that if I choose to participate in Sport Clubs without my own health insurance policy and am injured, my legal options will be as detailed in the "Release of Liability, Waiver of Right to Sue, Assumption of Risk and Agreement to Pay Claims" document I have signed. By entering my full name below, I acknowledge that I have read the above statement regarding health insurance coverage. - must contain at least 4 characters. Sacramento State Sport Clubs Program - Concussion Statement of Responsibility Personal Responsibility I understand that it is my responsibility to report all injuries to the Sport Clubs Advisor. Concussion Management Policy Please see the link below for the Sacramento State Sport Clubs Concussion Management Policy. This information can also be found in the files section of OrgSync. http://www.csus.edu/soal/sport-and-recreation-clubs/pdfs/concussion-management1.pdf [ ] I confirm that I have read and been given access to the Sacramento State Sport Clubs Concussion Management Policy. I understand the following information regarding concussions and will abide by the appropriate protocol outlined below: Page 5 of 9 2015-2016 Sport Club Coach Application

A concussion is a brain injury, which I am responsible for reporting to the Sport Clubs Advisor, and my club's Safety Officer and President. A concussion can affect an individual's ability to perform everyday activities, and affect reaction time, balance, sleep, and classroom performance. You cannot see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. If I suspect a club member has a concussion, I am responsible for reporting the injury to the Sport Clubs Advisor, and my club's Safety Officer and President. I will not allow a club member to return to play in a game or practice if they have received a blow to the head or body that results in concussion-related symptoms. I will follow the Return to Play protocol set forth by the Sport Clubs Program. Following a concussion, the brain needs time to heal. An individual is much more likely to have a repeat concussion if they return to play before their symptoms resolve. In rare cases, repeat concussions can cause permanent brain damage, and even death. By entering my full name below, I am agreeing to the above Sacramento State Sport Clubs Program Concussion Statement of Responsibility. Driving Page 6 of 9 2015-2016 Sport Club Coach Application

You have indicated that you are interested in becoming a driver for your sport club. Sport Club drivers must do the following before they are approved to drive to and from sport club competitions: - Complete the Sac State Sport Clubs Driving Packet - Complete the Defensive Driver Training Course (link can be found on cover page of Driving Packet) - Submit a copy of driver's license - Submit a copy of valid vehicle insurance - Submit signed/dated Defensive Driver Training - Online Self-Certification Acknowledgement *Please visit the link below to access the driving packet and the link for the Defensive Driver Training Online Course. Once you have completed the driving packet and online course, please submit the completed packet, signed/dated Defensive Driver Training certificate, copy of driver's license, and copy of valid vehicle insurance to Josh Mandel-Sonner (Sport Clubs Advisor) at Student Organizations & Leadership (2nd floor of University Union). http://www.csus.edu/soal/sport-and-recreation-clubs/sport-clubs/assets/sport%20clubs%20driver%20packet.pdf YOU ARE NOT ELIGIBLE TO DRIVE TO AND FROM SPORT CLUB COMPETITIONS UNTIL BOTH YOUR DRIVING PACKET AND 2015-2016 SPORT CLUB COACH APPLICATION HAVE BEEN APPROVED. Student Organizations & Leadership Handbook All sport club members and coaches are responsible for abiding by the policies covered in the 2015-2016 Student Organization Handbook and Student Conduct Code. Links to both documents are provided below: Student Organization Handbook: http://www.csus.edu/soal/pdf/handbook.pdf Student Conduct Code: http://www.csus.edu/umanual/student/ums16150.htm *The 2015-2016 Student Organization Handbook includes a Sport Clubs Addendum (pages 75-112). Sport Clubs Transgender Policy Transgender Policy Certain club sports are gender specific based on the league/conference that the club competes under. In order to comply with league/conference rules and National Governing Body rules, club members and coaches need to familiarize themselves with the Sport Clubs Transgender Policy. Please visit the link below. This information can also be found in the files section of OrgSync. http://www.csus.edu/soal/sport-and-recreation-clubs/pdfs/transgender%20policy.pdf that I have read and will follow the Sport Clubs Transgender Policy. Title IX Information The California State University (CSU) is committed to creating and sustaining an educational and working environment free of Sex Discrimination, Sexual Harassment, Sexual Misconduct, Dating and Domestic Violence, and Stalking. California state law mandates that universities provide education on the issues of sexual violence to all students. Title IX prohibits discrimination in educational institutions and requires that all colleges and universities receiving federal funding provide information and education to all incoming students. It also requires that students be made aware of all university policies and procedures regarding discrimination, harassment, and violence as well as the potential outcomes for policy violation. What is "sexual violence"? Sexual Violence is a form of Sexual Harassment and means physical sexual acts, such as unwelcome sexual touching, Sexual Assault, Sexual Battery, Rape, Domestic Violence, Dating Violence, and Stalking (when based on gender or sex) perpetrated against an individual against his or her will and without consent or against an individual who is incapable of giving consent due to that individual's use of drugs or alcohol, status as a minor, or Disability. (CSU Policy Executive Order 1095) Facts About Sexual Assault Sexual assault is an act of violence, sex is the weapon Sexual violence affects everyone. Sexual violence can happen to anyone, anywhere at any time. Most people tell the truth about sexual assault. Only 2-8% are false reports Most (86%) of sexual assaults are perpetrated by a non-stranger. (NISVS 2010) Most men don t rape, but the few that do, commit multiple rapes as well as other assault. Majority of perpetrators remain undetected in our community they are not caught. Page 7 of 9 2015-2016 Sport Club Coach Application

FACTS ABOUT RELATIONSHIP VIOLENCE 1 in 4 women will be a victim of relationship abuse. 85% of victims of physical relationship abuse are women. Women ages 20-24 are at the greatest risk of nonfatal relationship abuse. 20%-30% of college dating couples experience at least one act of physical aggression. 70-90% of college dating couples experience psychological aggression. Campus Resources for Reporting Sexual Violence Office for Equal Opportunity: 916-278-5771 Sacramento State Police Department: 916-278-6000 *For more information about Title IX and sexual violence or harassment, please visit http://www.csus.edu/titleix/ *For more information on bystander intervention education, please contact Sport Clubs Advisor, Josh Mandel-Sonner at Joshms@csus.edu or (916) 278-6731. Sexual Violence Oath that I have been given campus resources to aid in the report of sexual violence Mandatory Reporter [ ] I acknowledge that I must report allegations of sexual violence by utilizing the campus resources covered above. Policies Specific to Sport Clubs Regarding Alcohol and Drugs Policies Specific to Sport Clubs Regarding Alcohol and Drugs a. Sport Club members and coaches are required to be drug and alcohol free when involved in Sport Club travel, practice, competition, event, or function. This includes being under the influence of, or in possession of, any intoxicating or illegal drug and/or the misuse of prescription drugs. b. Wearing Sport Club team uniforms, jerseys, or other team paraphernalia while consuming alcohol or at a drinking establishment, regardless of age, is prohibited. c. Promoting or advertising Sport Clubs while consuming alcohol or at a drinking establishment is prohibited. d. Clubs are at all times responsible for guests, spectators, and participants at their events, and will be held accountable for the actions of these persons. e. Sport clubs are responsible for refusing admission to their activities of persons under the influence or in possession of alcoholic beverages. f. If needed, the club must provide gate attendants to assist in preventing alcohol from entering the facility. By checking the box below, I agree to the policies stated above. I understand that failing to abide by these polices can result in the loss of eligibility for Sport Club participation and individual/team sanctions. By entering my full name below, I am agreeing that I have read and understand the policies above and will report violations as soon as they are brought to my attention. Media Release Media Release I release to Sacramento State Sport Clubs, Student Organizations & Leadership, and Sacramento State the use of any picture(s), video(s), or likeness(es) taken or created by an agent of Sacramento State Sport Clubs, Student Organizations & Leadership, or Sacramento State for future use. Additional Paperwork The following two forms and a copy of your driver's license must be on file with Student Organizations & Leadership in order to coach a sport club team. We will send you these forms via email once your application has been processed. A parking pass request form will also be emailed to you so that you can request a complimentary parking pass. HR Volunteer Identification Form Coach Contract & Agreement Form (must be signed by the club president & treasurer) Page 8 of 9 2015-2016 Sport Club Coach Application

Application Signature By entering my full name below, this serves as an electronic signature for this application. Page 9 of 9 2015-2016 Sport Club Coach Application