Head Coach Registration (Raiders Hockey Club)

Print Head Coach Registration
Team
Please select the team you are associated with and your position on that team staff.
  1. Example: U12
Personal
Please enter your name, date of birth and complete address.
  1. The name entered here must be the same as the name entered when registering for Certification Clinics
  3. RadDatePicker
    RadDatePicker
    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
  5. City Only, Please DO NOT include Province
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
  1. Example: yo[email protected]. Your submission will be sent to this address.
  2. Example: ###-###-####
  3. Example: ###-###-####
Certification
Please insert your current level of certification in each category if applicable. All team personnel must have PRS Certification.
Police Check
Valid Police Checks must have an issue date after January 1, 2017
  2. RadDatePicker
    RadDatePicker
    Open the calendar popup.
  3. Allowed extensions: .jpeg, .jpg, .png, gif, .pdf.
    Maximum # Files: 4. Maximum File Size: 4MB.
Comments
  1. Add comments here as to why a form has been edited and Re-Submitted
Human Validation