2021-22 Team Personnel Information Form (Hamilton Huskies)

Print 2021-22 Team Personnel Information Form

PLEASE NOTE: Rowan's Law Concussion Code of Conduct and relevant Concussion Awareness Resource must be reviewed prior to every year of participation and before completing the acknowledgement form.

2021-22 HAMILTON HUSKIES TEAM

Please select the team you are associated with and your position on that team's staff.

2021-22 Hamilton Huskies Team^*
Team Position^*

PERSONAL INFORMATION

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^*

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

Address^*
City^*

City Only, Please DO NOT include Province
Postal Code^*

CONTACT INFORMATION

Please list the email addresses and phone numbers you wish to share. We must have 1 email address and 1 phone number from each staff member for communication purposes. YOU CONTROL WHAT WE MAKE PUBLIC FOR PRIVACY REASONS SO PLEASE CAREFULLY SELECT 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

Primary Email 1 (Confirmation of form submission will be sent to this email address)^*

Example: [email protected] Your submission will be sent to this address.
Email 2 MUST BE DIFFERENT THAN EMAIL 1

Not mandatory. ONLY ADD A 2nd EMAIL IF YOU WOULD LIKE IT ADDED TO YOUR TEAM'S EMAIL ALIAS TO RECEIVE WEB SITE NOTIFICATIONS SENT TO BOTH ADDRESSES IE: BOTH HOME AND WORK
Please Indicate Which, If Any, Email Address You Would Like To Display PUBLICLY IN YOUR TEAM PROFILE. ^*
NonePrimary Email 1Email 2
You can only make one selection here as one Email per team staff member is sufficient. As recommended above it should be the Head Coach and / or the Manager as a minimum per team so the team can be contacted by anyone viewing the Web Site. YOU MUST BE AWARE OF THE POTENTIAL FOR PHISHING SCAMS VIA EMAIL WHEN YOU PUBLICLY DISPLAY AN EMAIL ADDRESS.
Select Which Email Address You Would Like Entered Into Your Team's Email Alias^*
NonePrimary Email 1Email 2
The Head Coach and Manager of all teams will have the email / emails of their choice entered into the team's Email Alias. The Email Alias is used by the Web Site to send out auto generated notifications of "last minute" Schedule changes (within 14 days of the Schedule item). The Email Alias and included Email addresses are not visible to the public. All team staff are encouraged to make this selection as well.
Home Phone

Example: ###-###-####
Cell Phone

Example: ###-###-####
Work Phone

Example: ###-###-#### x###
Please Indicate Which, If Any, Phone Number You Wish To Display PUBLICLY IN YOUR TEAM PROFILE^*
NoneHome PhoneCell PhoneWork Phone
Check the appropriate box. Phone numbers checked will appear on the Web Site. YOU MUST BE AWARE OF THE POTENTIAL FOR PHISHING SCAMS VIA TEXT WHEN YOU PUBLICLY DISPLAY A PHONE NUMBER

CERTIFICATIONS

Please insert your current level of certification in each category if applicable. All team personnel must have PRS Certification.

Hockey Canada Hockey ID

Please enter your HCR ID# if you know it
Coach Certification^*
Trainers Certification^*
PRS - Prevention Services^*
Gender Identity and Sensitivity Modules Completed^*
YesNo
Rowan's Law Concussion Awareness^*
YesNo
Rowan's Law Concussion Code of Conduct and relevant Concussion Awareness Resource must be reviewed prior to every year of participation and before completing thE acknowledgement form.
Are You In Possession Of A Current Police Vulnerable Sector Scan (VS)^*
YesNo
Obtained in either 2018 or 2019

FORM RE-SUBMITTED COMMENTS - ADMIN USE ONLY

IF THE FORM IS EDITED THIS TEXT BOX WILL EXPLAIN WHAT WAS EDITED AND WHY.

Form Re-Submitted Comments for Admin Use Only

Add comments here as to why a form has been edited and Re-Submitted

Human Validation

Check The Box ^*

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Mon Mar 08, 2021

Printed from hamiltonhuskies.ca on Monday, March 8, 2021 at 5:28 AM