NVMHA COACH APPLICATION FORM
For questions or further information on coaching at NVMHA contact Dan Cioffi - operations@nvmha.com
First Name
Your answer
Last Name
Your answer
Address
full address including postal code
Your answer
Phone
Mobile
Your answer
Phone alternate
What other number can we contact you at?
Your answer
Email address
Your answer
Date of Birth
MM
/
DD
/
YYYY
Hockey Canada Record (HCR) Number
can be found on your hockey canada profile
Your answer
Are you currently under probation or suspension from coaching duties within any other association
If yes, please provide details:
Your answer
Have you ever been convicted of a criminal offense
Do you have criminal charges pending?
If yes to either of the previous two question please provide details
Your answer
NVMHA requires all volunteers, employees and contractors to complete a Criminal Records Check or Volunteer Disclosure Form annually. Forms for both can be found in the Coaches>Resources section of the NVMHA website. Please confirm you under stand this requirement. *
Coaching Assignment Requested FIRST CHOICE
Coaching Assignment Requested SECOND CHOICE
For Rep - please choose the level
Please indicate certification and training that you have completed
Coaching Experience 2016-17 Season
include team, level, association and your position
Your answer
Coaching Experience 2015-16 season
include team, level, association and position
Your answer
Coaching Experience 2014-15 season
include team, level, association and position
Your answer
Other relevant experience
Your answer
Briefly describe your coaching philosophy
Your answer
Do you have a child registered in NVMHA
Are you willing to coach a team your child is not on?
If a coaching position were not available in the age group of your choice, would you be willing to coach in another division and/or help out with skill development and player evaluation?
If yes, which division?
Your answer
Do you have the required certification level for the team for which you are applying??
If not certified at the required level, are you willing and available to take the appropriate course to attain the required level of certification?
Coaching References
Please provide the name, phone and email for three coaching references
Your answer
Undertaking *
I hereby consent to disclosure of the above information. I hereby agree to obtain a criminal record check and any subsequent back ground checks as required by the association and BC Hockey. I hereby acknowledge the authority of the BC Hockey, PCAHA and the North Vancouver Minor Hockey Association and agree to carry out and abide by their constitution, bylaws, rules and regulations. I hereby agree to familiarize myself with the National Coaching Certification Program (NCCP) requirements for coaching minor hockey and ensure that I maintain the required level of certification.
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