EmailMe Form - Port Dover Minor Hockey Association

Name *

First Last

Email *

Secondary Email (N/A if not applicable) *

Cell Phone *

### - ### - ####

Home Phone (000-000-0000 if not applicable) *

### - ### - ####

Address *

Street Address City State / Province / Region Postal / Zip Code

Position Applying For: *

Head Coach

Assistant Coach

Team Trainer

Team Manager

Division of Team You Are Applying For? *

If you are applying for but not selected for Head Coach of the team you are applying for, would you be willing to assist another Head Coach? *

Yes

No

If your choices are not available would you be willing to coach another team? *

Yes

No

Coaching Experience (Past Two Years)
***If no coaching experience enter N/A in the fields below *

1) Year and Team/Association
Position Held
2) Year and Team/Association
Position Held

Coaching / Trainer Qualifications (Attach File if Required) *

Current Level
Other Qualifications You Hold
Refresher/Upgrade Courses You Have Attended

Please Explain Your Coaching Philosophy. *

Briefly Summarize Your Seasonal Plan.(team initiatives, objectives and goals) *

Have you completed the mandatory Gender Identity and Gender Expression Training for Team Officials? *

Yes

No

Have you completed the Preventative Services / Speak Out / Respect in Sport Course? ( This does not include the Parent Respect in Sport) *

Yes

No

Coach Applicant Acknowledgement: (If Selected as a Coach or Team Official for Port Dover Minor Hockey Association) *

	I Understand and Agree to the Following Terms and Conditions
Teach and display fair play and sportsmanship and expect the same from all my players and coaching staff.
Abide by all Hockey Canada /OHF/OMHA and PDMHA constitutions, bylaws, rules and regulations .
Participate in on ice sessions of the PDMHA conditioning school held in September. Or designate a member of your coaching staff.
Provide a list of my team officials (Manager,Assistant Coaches,Trainer etc) to PDMHA by September 30/2021
I agree to complete a Police Criminal Record Vulnerable Sector Check as per PDMHA protocol prior to the teams first training session.
An Interview may be requested at the discretion of the PDMHA Coaches Selection Committee.

***(Optional )***Please attach your personal resume, reflecting your coaching experiences and any other information which is not detailed in this application (i.e. employment, playing experiences, other interests,references etc…).

Date Application Submitted
(Must Be Submitted Before 8:00 pm Tuesday, September 15 /2024) *

MM / DD / YYYY