Contact Information

Name:

Home Phone:

Street:

Work Phone:

City:

Other Phone:

Postal:

E-Mail:

Certification

ALL team staff require Prevention Services (Speak Out) certification.  Please bring your police clearance to your interview or fax it to (905) 631-1387 .

Please indicate any Certifications you have attained.

Level

Registration Number

Expiry Date

Prevention Services

n/a

NCCP Initiation Program

NCCP Coach Level

NCCP Intermediate Level

n/a

HTCP Trainer Level  I/II

Police Clearance

Other

Desired Level

1st Choice

2nd Choice

Level

SelectAAABBHL

SelectAAABBHL

Age Group

SelectTykeNoviceAtomPeeweeBantamMidgetIntermediateSenior

SelectTykeNoviceAtomPeeweeBantamMidgetIntermediateSenior

Would you be willing to be an Assistant Coach on a team? 

SelectYesNo

Prior Experience

Please describe your hockey coaching experience

Please describe any other coaching experience.

Please describe your hockey playing experience

Additional Information

Please describe training courses taken and accreditations earned

If your daughter(s) is (are) playing hockey this year, please indicate age group, city and competitive level played for the 2010-2011 season, along with their birth date.

Please indicate why you wish to coach in the Burlington Girls Hockey Club.  Briefly describe your coaching philosophy.

References

Please list two references that are familiar with your hockey background

Name

Home Phone

Work Phone

*Only the head coach will be selected before the start of next season.