Name:
Address
Phone Number
Cell Phone Number
Email Address:
What team is your first coaching choice?
Would you have a child on this team?	Select one Yes No
What team is your second choice for coaching?
Would you have a child on this team?	Select one Yes No
Comments about your coaching choices (if necessary)
What level of NCCP Certification do you have?	Select One Level Coach Intermediate Advanced What's This???
Do you have Trainers Certification?	Select one Yes No
Have you taken the Prevention Services (abuse and harassment) course?	Select one Yes No Whats that?
Have you previously submitted a Police Check to either SSE or LMHA?	Select the most appropriate answer Yes, in the past 2 years Yes, more than 2 years ago No, I have not submitted one
Detail your Coaching experience:
What experience do you have playing hockey?
Do you already have bench staff in mind?	Select one Yes No
Identify any bench staff you are considering, and the position you are thinking they may hold.
**Please note - To confirm your submission, you will receive an email from the Chair of the Bandit Committee. If you do not receive that email please email us at sselha@rogers.com