CoachArt

To be completed by potential coaches in the outpatient coaching program, in-hospital workshops and program events.

Are you 18 years of age or older?

Yes No

I am interested in becoming a coach for:

	Outpatient Coaching Program (10 lessons, 10 weeks, individual or small group)
	Hospital Workshops (Two 2 hour sessions at Childrens Hospital each quarter)
	Program Events (special events, field trips or workshops)

Activities I am qualified to coach and basis for qualification: (i.e. painting, flute, guitar, etc.)



Have you ever been convicted of a crime other than a minor traffic violation? Yes No

If yes, please explain:

*Note that criminal convictions will prohibit you from becoming a volunteer with CoachArt.


I plan to attend the following Volunteer Orientation:

All orientations take place at CoachArt, 3303 Wilshire Boulevard,
Suite 320
Los Angeles, CA 90010