Coach/Trainer Reimbursement Form (Peterborough Girls Hockey Association)
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Coach/Trainer Reimbursement Form
This form is for all Peterborough Girls Hockey Association REP and House League team staff for certification reimbursement. **** Please submit a new form for each course taken **** ONLY SUBMIT ONCE YOU HAVE PASSED THE COURSE **** Reimbursement will be made once you are rostered to a team or added to our volunteer list **** Reimbursement is for course fee only ****
REQUIRED ITEMS:
Coaches: Coach certification, Respect In Sport Activity Leader, Valid Police check/Declaration
(the coach certification required will vary depending on the level of hockey you are coaching)
Trainers: Trainer Certification, Respect In Sport Activity Leader, Valid Police check/Declaration
Managers: Respect In Sport Activity Leader, Valid Police check/Declaration
OWHA Site: www.owha.on.ca
Contact Information
First and Last Name
*
Address
*
Number / Street Name
City
*
Postal Code
*
A1B2C3
Contact Number
*
Example: ###-###-####
Email Address
*
Example:
[email protected]
Team Information
Which team are you requesting this for?
Select Your Team
*
Select One...
U13T1 - U13 - Group 1 (Martone)
U13T1 - U13 - Group 2 (deLaPlante)
U13T2 - U13 - Group 3 (Jacobs)
U13T2 - U13 - Group 4 (Medhurst)
U15T1 - U15 - Group 1 (Moher)
U15T1 - U15 - Group 2 (Merrick)
U15T2 - U15 - Group 3 (Leclair)
U15T2 - U15 - Group 4 (Gillespie)
U18T1 - U18 - Group 1 (Foote)
U18T1 - U18 - Group 2 (Naklicki)
HLS - Group 1 (2011, 2012, 2013)
HLS - Group 2 (2008, 2009, 2010)
U21 - U21 (Hutton)
HL - U9 - Maroon - Team 1
HL - U9 - White - Team 2
HL - U9 - Blue - Team 3
HL - U9 - Green - Team 4
HL - U11 - Team 1 - Silver
HL - U11 - Team 2 - Red
HL - U11 - Team 3 - Blue
HL - U11 - Team 4 - White
HL - U13 - Blue - Team 1
HL - U13 - Red - Team 2
HL - U13 - White - Team 3
HL - U15/U18 - Blue - Team 1
HL - U15/U18 - Green - Team 2
HL - U15/U18 - Grey - Team 3
HL - U15/U18 - Red - Team 4
HL - U15/U18 - White - Team 5
U21
Senior BB/B
U9 - U9 - Group 1 (Kilcollins)
U11T1 - U11 - Group 1 (Hancock)
U11T1 - U11 - Group 2 (Rutledge)
U11T1 - U11 - Group 3 (Johnson)
Position on Team
*
Select One...
Coach
Trainer
Manager
Coach, Trainer, Manager
Clinic Information
Enter Information for the clinic attended
Type
*
Select One...
COACH - DEVELOPMENT 1
COACH - INSTRUCTIONAL STREAM
COACH - PROFESSIONAL DEVELOPMENT
COACH 1 - INTRO TO COACH
COACH 2 - COACH LEVEL
HU - ONLINE Coach 1/2
TRAINER - HTCP Level 1
TRAINER - HTCP Level 1 Refresher
ALL - RESPECT IN SPORT-ACTIVITY LEADER
POLICE CHECK with VULNERABLE SECTOR SCREENING
Police check, Trainer, Coach, Respect In Sport
Fee
*
Enter the amount of the fee for this certification
Clinic Location
*
Clinic Date
*
RadDatePicker
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Calendar
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Attachment
Receipt & Certification Attachments
Please attach scanned copy of receipt
*
Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx.
Maximum # Files: 5. Maximum File Size: 4MB.
Please attach scanned copy of certitication
*
Allowed extensions: .jpeg, .jpg, .png, .gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 5. Maximum File Size: 4MB.
Human Validation
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