Head Coach Registration (Raiders Hockey Club)
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Head Coach Registration
Team
Please select the team you are associated with and your position on that team staff.
21-22 Raiders Team
*
Example: U12
Team Position
*
Select One...
Head Coach
Assistant Coach
Manager
Trainer
Personal
Please enter your name, date of birth and complete address.
First Name
*
The name entered here must be the same as the name entered when registering for Certification Clinics
Last Name
*
Date of Birth
*
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
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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
*
City
*
City Only, Please DO NOT include Province
Postal Code
*
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
Email Address
*
Example: yo
[email protected]
. Your submission will be sent to this address.
Home Phone
Example: ###-###-####
Cell Phone
Example: ###-###-####
Certification
Please insert your current level of certification in each category if applicable. All team personnel must have PRS Certification.
Coach Certification
Select One...
Coach Level / Stream
Development 1 (D1 / DS1) Trained
Development 1 (D1 / DS1) Certified
High Performance 1 (HP 1) Trained
High Performance 1 (HP1) Certified
High Performance 2 (HP 2) Trained
High Performance 2 (HP2) Certified
Certification Required
Trainers Certification
Select One...
Level 1 HTSP
Level 2 HTSP
Level 3 HTSP
Certification Required
Respect in Sport
*
Select One...
Speak Out
Respect in Sport (RIS)
Certification Required
Gender Identity and Sensitivity Modules Completed
*
Yes
No
Police Check
Valid Police Checks must have an issue date after January 1, 2017
Status
Select One...
In Progress (email to
[email protected]
when received)
Completed (Attach below)
Date Issued
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
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May 2023
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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.
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