Coach For Us! Coach For Us! Are you interested in coaching for the Vipers? Complete this application and we will be in touch! "*" indicates required fields Name* First Last Email* Phone*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please provide 3 references that we may contact.*Please list Name, Phone Number, Email, and Years KnownUS Lacrosse #:* Participation Waiver & Code of Conduct* I agree to the participation waiver and code of conduct.In my participation of Fort Collins Youth Lacrosse d/b/a NOCO Vipers Lacrosse events, camps and activities, I agree to the following; 1. I, hereby voluntarily agree to release, waive, discharge, hold harmless, defend, and indemnify NOCO Vipers Lacrosse and their representatives, coaches, officials, referees, board of directors, employees, and volunteers from any and all claims, actions or losses for bodily injury, property damage, injury, that otherwise may arise out of my use of any equipment or participation in these camps, leagues or activities.I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death, as well as other damages and losses, associated with participation in a lacrosse event and related sports conditioning activities. 2. In the event of such illness or injury, I authorize the appropriate parties to obtain necessary medical treatment and hereby, release and hold harmless NOCO Vipers Lacrosse coaches, officials, referees, board of directors, employees and volunteers in the exercises of this authority. I further acknowledge and understand that I will be responsible for any and all medical and related bills that may be incurred on my or my child/children's behalf for any illness or injury that may be sustained during the camp, league or activity. Code of Conduct: I have read and agree to all terms in the NOCO Vipers Lacrosse Code of Conduct, especially with regard to my responsibilities as a Player. NOCO Vipers Lacrosse Code of Conduct All people associated with the game are expected to act with sportsmanship, dignity and respect for others. This includes coaches, parents, players and referees. Poor sportsmanship includes: ·Arguing with coaches, officials, teammates, opponents or spectators ·Using threatening or profane language ·Baiting or taunting coaches, officials, teammates, opponents or spectators ·Unsafe play ·Uncontrolled behavior in the bench area Poor sportsmanship will carry, at a minimum, the following consequences: First Offense Verbal warning Second Offense Dismissal from the camp, league, game or activity Third Offense Dismissal from the camp, league, game or activity Fourth Offense Dismissal from NOCO Vipers Lacrosse We, parent(s) and player, have discussed the NOVO Vipers Lacrosse Code of Conduct and agree to abide by it. We understand that there is no refund or recourse for dismissal from our program as a consequence of breaking this Code of Conduct. As legal guardian of this participant, I hereby verify by my signature below that I have read and fully understand each of the above conditions for permitting my child or children to participate in any NOCO Vipers Lacrosse camp, league or activity, and I accept each of the above conditions, especially the waiver and release set forth in paragraph one. This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and, for myself, my heirs, assigns, and next of kin. I release and agree to indemnify and hold harmless Fort Collins Youth Lacrosse d/b/a NOCO Vipers Lacrosse from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. Photo Release* I agree to the photo release.Appearance Agreement. I understand that NOCO Vipers Lacrosse from time to time produces promotional material relating to its camps, leagues or activities. I understand that my child as a participant and/ I as a spectator may be included in videos or photographs taken during the camps, leagues or activities. By clicking below, I without reservation or limitations, I hereby assign, transfer and grant to NOCO Vipers Lacrosse the right to photograph and / or video my child and/or myself and to utilize such videos and photographs and my/my child's name, face likeness, voice and appearance as a part of the camp/league or activiting in advertising and promoting NOCO Vipers Lacrosse. I further understand that neither NOCO Vipers Lacrosse nor any third party is under any obligation to exercise any of the foregoing rights, licenses and privileges. Please print Name and Date as your agreement with the participation waiver, code of conduct, and photo release.* Concussion CertificationMax. file size: 650 MB. 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