Grand Lake Minor Hockey Association
Coach Application Form
Applicant Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
*
Street Address
City
Province
Postal / Zip Code
Division to Coach
*
Applying for:
*
Head Coach
Assisstant Coach
Past Coaching Experience
*
Rows
Team and Division
Years
Reference Name
Reference Phone Number
1
2
3
4
5
Qualifications
Hockey Canada Coach Level 1?
*
Yes
No
Hockey Canada Coach Level 2?
*
Yes
No
The Shift Forward (Or former Respect in Sport For Activity Leader)?
*
Yes
No
Hockey Canada Safety Program 1?
*
Yes
No
Attached a Criminal Record & Vulnerable Sector Check?
*
Yes
No
Are you willing to attend above clinics if required?
*
Yes
No
Assistant Coache(s):
Manager:
Signature
Criminal Record & Vulnerable Sector Check: Can also be sent to glmharegistrar@gmail.com
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