2023-24 Team Personnel Information Form (Hamilton Huskies)

2023-24 HAMILTON HUSKIES TEAM

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

2023-24 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^*

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

Please Indicate If You Would Like To Display Your Email PUBLICLY IN YOUR TEAM PROFILE. ^*

NoYes

Home Phone

Example: ###-###-####

Cell Phone

Example: ###-###-####

Please Indicate Which, If Any, Phone Number You Wish To Display PUBLICLY IN YOUR TEAM PROFILE^*

None
Home Phone
Cell 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^*

Trainers Date of Expiry

Please enter the date of Expiry for your Trainers Certification.

PRS - Prevention Services^*

Gender Identity and Sensitivity Modules Completed^*

YesNo

Are You In Possession Of A Current Police Vulnerable Sector Scan (VS)^*

YesNo

If you have been away from the Huskies or have never been on Huskies Staff, you must provide a current year police check

2023-24 Team Personnel Information Form (Hamilton Huskies)

ALLIANCE HOCKEY Digital Network

2023-24 HAMILTON HUSKIES TEAM

PERSONAL INFORMATION

CONTACT INFORMATION

CERTIFICATIONS

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