Clinic Hosting Request

Clinic Hosting Request
Applicant Information
Season
Name of MHA
If "Other", please provide MHA name
District*
MHA Clinic Contact Name*
Phone*
Will appear on BC Hockey website
Email*
Will appear on BC Hockey website
Address

(mailing address of the submitter, may be used for the purpose of provide physical supplies, e.g. crests)
Street Address*
City*
Province*
Postal Code*
Clinic Information
Type of Clinic*

HCOP - Officiating ClinicInstructional Stream – Specialty Clinic
NOTE: MHAs will be required to supply a clinic instructor for any clinics being run for NEW / First-time officials.

Upon confirmation of your clinic request and the provision of registration link(s), BC Hockey will also provide the submitter with electronic access to clinic curriculum material for use by the MHA provided instructor.

For all returning official ‘re-certification’ clinics, please indicate if your MHA is able allocate an instructor or if your require an instructor to be provided to you by BC Hockey:
HCOP - Instructors

Yes, our MHA will supply an instructor(s)No, our MHA is unable to supply an instructor(s), therefore we require our District Officiating Delivery Group Member to review our clinic request for the purpose of assigning an applicable instructor(s)
Instructor 1 Full Name*

First NameLast Name
Clinic Instructor 1 Will Host*
Add Instructor 2?

Yes
Instructor 2 Full Name

First NameLast Name
Clinic Instructor 2 Will Host
Add Instructor 3?

Yes
Instructor 3 Full Name

First NameLast Name
Clinic Instructor 3 will host
Additional Comments
Speciality

CheckingGoaltendingDeveloping DefencemenPuck SkillsShooting and ScoringSkatingSmall Area Games
Classroom Session Start Date*

YearMonthDay
Classroom Session End Date*

YearMonthDay
Classroom Session Start Time*

Hour Minutes

AM/PM Option
Classroom Session End Time*

Hour Minutes

AM/PM Option
Ice Session Start Date

YearMonthDay
Ice Session End Date

YearMonthDay
Ice Session Start Time

Hour Minutes

AM/PM Option
Ice Session End Time

Hour Minutes

AM/PM Option
Registration Deadline*

YearMonthDay
Visibility*

PublicPrivate
Clinic Level & Attendees
Officials

NewReturning
Estimated Attendees (max number)

If none, then enter "0".
U9 Cross-Ice
Level 1
Level 2 - 16-17 yrs old
Level 2 - 18+ yrs old
Level 3 - 17 yrs old
Level 3 - 18+ yrs old
Facility Information
Facility Name*
Where to meet
Classroom (if applicable)
Does the facility have I.T. access? (e.g. wi-fi, projector)*

YesNo
Facility Address
Facility Street Address*
Facility City*
Facility Province*
(NOT posted on website)
Facility Postal Code*
Ice Session Arena Address (if different from classroom facility)
Billing Information
MHA Billing Address
Billing Street Address*
Billing City*
Billing Province*
Billing Postal Code*
Submission Date

YearMonthDay
Date
Hour Minutes
Status
Should be Empty:

Clinic Hosting Request

Applicant Information

Address

Clinic Information

Clinic Level & Attendees

Estimated Attendees (max number)

Facility Information

Facility Address

Billing Information

MHA Billing Address