Clinic Reimbursement Request Form

Clinic Reimbursement Request Form

Per 6.5.2 : If the total reimbursements exceed $500.00, the team may apply to the Association for a subsidy to cover the remaining amount. This subsidy is only available when reimbursing a maximum of one (1) Head Coach, three (3) Assistant Coaches, one (1) HCSP and one (1) Team Manager. Teams carrying a larger team staff are not eligible for reimbursement from RMMHA for those additional team officials’ certifications. To claim this amount please complete the below form and submit a copy of all receipts.
Please fill out one form PER TEAM ONLY.
Submitter's Name*

First NameLast Name
Submitter's Email*
example@example.com
Mailing Address for Cheque*

Street Address

Street Address Line 2

CityProv

Postal Code
Team*
Receipts Upload

FUNDS WILL NOT BE REIMBURSED WITHOUT RECEIPTS. Upload all receipts, even those that are within the $500 paid by the team.
Please fill out one form PER TEAM. Each receipt uploads section is ONE PERSON. UPLOAD DOCUMENTS TO THE CORRECT OFFICIAL'S BOX.

ALL RECEIPTS MUST BE ATTACHED - EVEN IF THE TEAM PAID FOR THE CLINIC/CERT BEFORE EXCEEDING $500. We must see that $500 was exceeded.
Receipts Upload - Head Coach

pdf, jpg, jpeg, png ONLY
Cancelof
Receipts Upload - Manager

pdf, jpg, jpeg, png, ONLY
Cancelof
Receipts Upload - Assistant Coach 1

pdf, jpg, jpeg, png ONLY
Cancelof
Receipts Upload - Assistant Coach 2

pdf, jpg, jpeg, png ONLY
Cancelof
Receipts Upload - HCSP

pdf, jpg, jpeg, png ONLY
Cancelof
Receipts Upload - ON ICE HELPER

pdf, jpg, jpeg, png ONLY
Cancelof
Dollar Amount Spent TOTAL*
Dollar Amount Requested - MUST MATCH RECEIPTS EXACTLY*
Should be Empty:

Clinic Reimbursement Request Form

Receipts Upload