Team Personnel (Raiders Hockey Club)

2020-2021 Spring Tryouts Postponed

Print Team Personnel

Team

Please select the team you are associated with and your position on that team staff.

2019-20 Jr Cougars Team^*

Required
Team Position^*

Required

Personal

Please enter your name, date of birth and complete address.

First Name^*

Required
The name entered here must be the same as the name entered when registering for Certification Clinics
Last Name^*

Required

Date of Birth^*

Open the calendar popup.

mm/dd/yyyy Type the date in using this format or select from the calendar. Birthdate is required when registering a coach to a roster in the Hockey Canada Registry

Address^*

Required
City^*

Required
City Only, Please DO NOT include Province
Postal Code^*

Required

Communication

Please list the email addresses and phone numbers you wish to share. We must have 1 email address and 1 phone number for communication purposes. You control what we make public for privacy reasons so please indicate which information, if any, that you would like to display in your team profile. A COPY OF THIS FORM WILL BE SENT TO PRIMARY EMAIL 1 AS CONFIRMATION OF YOUR SUBMISSION

Primary Email 1 (Confirmation of form submission will be sent to this email address)^*

Required
Example: [email protected] Your submission will be sent to this address.
Email 2 If Different than Email 1

Not mandatory. Only add 2nd Email if you would like it added to your team's Email Alias to receive Web Site notifications to both addresses ie work and home
Please Indicate Which, If Any, Email Address You Would Like To Display Publicly In Your Team Profile^*

NonePrimary Email 1Email 2Required
You can only make one selection here as one Email per team staff member is sufficient. As recommended above it should be the Head Coach and / or the Manager as a minimum per team so the team can be contacted by anyone viewing the Web Site
Select Which Email Address You Would Like Entered Into Your Team's Email Alias^*

NonePrimary Email 1Email 2
The Head Coach and Manager of all teams will have the email / emails of their choice entered into the team's Email Alias. The Email Alias is used by the Web Site to send out auto generated notifications of "last minute" Schedule changes (within 14 days of the Schedule item). The Email Alias and included Email addresses are not visible to the public. All team staff are encouraged to make this selection as well.
Home Phone

Example: ###-###-####
Cell Phone

Example: ###-###-####
Work Phone

Example: ###-###-#### x###
Please Indicate Which, If Any, Phone Number You Wish To Display Publicly In Your Team Profile^*

NoneHome PhoneCell PhoneWork Phone
Check the appropriate box. Phone numbers checked will appear on the Web Site.

Certification

Please insert your current level of certification in each category if applicable. All team personnel must have PRS Certification.

Hockey Canada Hockey ID

Please enter your HCR ID#
Coach Certification
Card Number:
Trainers Certification
Card Number:
PRS - Prevention Services^*

Required
Card Number:
Gender Identity and Sensitivity Modules Completed^*

YesNoRequired

Police Check

Valid Police Checks must have an issue date after January 1, 2017

Status

Date Issued

Open the calendar popup.

Please scan or take a picture of both the front and back of Police Check and upload here.

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf.
Maximum # Files: 4. Maximum File Size: 4MB.

Comments

Form Re-Submitted Comments for Admin Use Only

Add comments here as to why a form has been edited and Re-Submitted

Human Validation

Check The Box ^*

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Fri May 29, 2020