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