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All individuals who will serve as coaches, assistant coaches, trainers, or will have direct contact with LYSA youth participants in their LYSA-required volunteer roles must fill out a background check form. Forms should be mailed to the LYSA address or faxed to the number below.

LYSA COACHING APPLICATION & BACKGROUND CHECK

Youth Leader Request
Pursuant to KRS 17.160
Organization:Lexington Youth Soccer Association (LYSA)
Address:c/o 3805 Hopemont Drive, Lexington, KY 40514
Contact Person:Nina O'Leary
Phone Number:Office: (859) 223-5632 Fax: (859) 223-8643
Tax Exempt Number:D14844
Background Checks are performed by:

Administrative Office of the Courts
Pretrial Services
100 Millcreek Park
Frankfort, Kentucky 40601
(800) 928-6381
The Background Check Process

The records requested will be returned to the mailing address (LYSA) in a postage paid self-addressed return envelope to LYSA. A separate addressed envelope for each person on which a Background Check has been requested is required and is provided by LYSA in order that individuals get to see the results of their Background Check. If you have any questions regarding the results of your Background Check, especially accuracy, please contact Pretrial Services at (800) 928-6381.
PLEASE FILL IN ALL FIELDS:
Social Security Number:
(123-45-6789)
Driver's License Number:
Date of Birth:
(MM/DD/YYYY)
Full Name:
Maiden or Alias Name:
Street Address/ P.O. Box:
City:
State:
Zip Code:
League: Recreational
Lexington FC
Age Group: Under -
Team Type: Mixed
Girls
Team Name:
Home e-mail:
Work e-mail:
Home phone:
Work phone:
What state did you live in for the last 6 months?
List in chronological order with dates, other states that you have lived in over the last 20 years.
Have you ever been removed or restricted from youth coaching in any sport? Yes No
Have you ever been convicted of a violent crime? Yes No
Do you have any convictions involving drugs? Yes No
Do you have any convictions that involve physical or sexual abuse? Yes No
Do you have any convictions as a sex offender? Yes No

I give LYSA the authority to resubmit this information to the Administrative Office of the Courts if needed. LYSA will only use the information provided to obtain background check information.
Yes No
 
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