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Thunder Bay ELKS Hockey Association Coaching Application Fill in the editable PDF, save the file using your name & email the saved copy to us: (Given name) (Middle) (Surname) Address: City: Postal Code: Phone: Home: Work: Cell: FAX: Email Address: Birth Date: Place of Birth: Employer: Occupation: Employers Phone: Address: Coaching Assignment Requested Division Indicate Division IP Novice Atom A AA PeeWee A AA Bantam A AA Midget A AA Certification / Training * Hockey Canada Coach Training Coach Development 1 (Head Coach AA only) Coach 2 (Head Coach all A Teams) Coach Level 1 Hockey Canada Checking Skills Clinic Intro level to Coach Level 1 (Minimum requirement for IP & Novice) Respect in Sport (RIS) / Speak Out required! Criminal Records Check required! Gender Identity required! Year completed Location Hockey Canada ID #: Page 1

Other Coaching Courses or Training Hockey Coaching Experience (List in order, starting with the most recent) Year Association and Team Name Age Group Position Other Sports Year Association Sport Position Coaching Staff (assistant coaches, trainer, manager, special events co-ordinator etc) Year Name Age Group Position Page 2

Briefly describe your Coaching Philosophy Do you have a child registered with Thunder Bay Elks Hockey Association? Yes: No: If a Coaching Position were not available in the age group of your choice, would you be willing to coach in another division or help out with skill clinics? Yes: No: (If Yes, which division?) Will you coach the team if an independent committee does not assess your child to make the team? (AA TEAMS ONLY) Yes: No: Are you certified for the level for which you are applying? Yes: No: If you are not certified at the required level, are you available to take a weekend course to attain the required level? Yes: No: Coaching References: (minimum of 2) Page 3

Undertaking 1. I hereby consent to disclosure of the above information. 2. I hereby acknowledge the authority of the Thunder Bay Elks Hockey Association and agree to carry out and abide by their constitution, bylaws, rules and regulations. 3. I hereby acknowledge that I have read and understand the coach s role as outlined in the Team Officials Contract attached to the forming part of this Coaching Application form. 4. I hereby agree to familiarize myself with the Hockey Canada Certification Program requirements for coaching minor hockey and ensure that I maintain the required level of certification. 5. Incomplete applications will NOT be considered. Signature: Date: Please submit your application: By email: elks82shockey@gmail.com By mail: Box 28082, 900 Arthur Street E. Thunder Bay, ON P7E 6R5 NOTE: Please sign the copy of the Team Officials Contract Page 4

Team Official s Contract It is the intention of this Contract to promote fair play and respect for all participants within the Association. All coaches must sign this Contract before being allowed to participate in hockey and must continue to observe the principles of Fair Play. Fair Play Code I will be reasonable when scheduling games and practices remembering that young athletes have other interests and obligations. I will teach my players to play fair and to respect the Rules, Officials, Opponents and Teammates. I will ensure all players receive equal instruction, discipline, support and appropriate fair play time. I will not ridicule or yell at my players for making mistakes or for performing poorly. I will remember that children play to have fun and must be encouraged to have confidence in themselves. I will make sure that equipment and facilities are safe and match the players ages and ability. I will remember players need a coach they can respect. I will be generous with praise and set a good example. I will obtain proper training and continue to upgrade my coaching skills I agree to abide by the principles of the fair play code as set by Hockey Canada and supported by Thunder Bay Elks Hockey Association. I also agree to abide by the Rules, Regulations and Decisions as set by Thunder Bay Elks Hockey Association. Print Name: Date: Signature: Page 5