Coach/Trainer Reimbursement Form (Peterborough Girls Hockey Association)

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, Rowan's Law Acknowledgement, registered in RAMP
(the coach certifications required will vary depending on the level of hockey you are coaching)

Trainers: HTCP Level 1 Trainer Certification, Respect In Sport Activity Leader, Valid Police check/Declaration, Rowan's Law Acknowledgement, registered in RAMP

Managers: Respect In Sport Activity Leader, Valid Police check/Declaration, Rowan's Law Acknowledgement, registered in RAMP

Den Moms: Respect In Sport Activity Leader, Valid Police check/Declaration, Rowan's Law Acknowledgement, registered in RAMP

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]. Your submission will be sent to this address.

Team Information

Which team are you requesting this for?

Select Your Team^*

Position on Team^*

Coach, Trainer, Manager, Den Mom

Clinic Information

Enter Information for the clinic attended

Type^*

Police check, Trainer, Coach, Respect In Sport

Fee^*

Enter the amount of the fee for this certification

Clinic Location^*

Clinic Date^*

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.

Direct Deposit Information

Please complete this section if you would like your reimbursement by direct deposit

Name of Bank of Financial Institution

Account Type

CheckingSavings

Bank Transit Number

(5 Digits)

Institution Number

(3 Digits)

Account Number

(1-12 Digits) Usually found before the (II') symbol. The exact location and number of digits may vary between banks.

Re-enter Account Number

(1-12 Digits)

Coach/Trainer Reimbursement Form (Peterborough Girls Hockey Association)

Contact Information

Team Information

Clinic Information

Attachment

Direct Deposit Information

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