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Webster Youth Hockey Association

Girls Program Coaching Application

 2005-2006 Season

Text Box: All Applications must be received by March 15, 2005
 

 

 

 


Name ____________________________      Home Phone _____________________

Address ____________________________             Alt Phone _____________________

City ________________, NY________                     Email ____________________________

 

__Girls 12U C     ____Girls 12U B     ___Girls 14U B        ____ Girls 19U C

 

 

Do you have a child playing?  Y  N       Name______________________________ DOB ____________

Child's last level of play ___________________ Organization _________________________________

 

Coaching Experience:

Position ________________ Level _________ Organization ___________________ Year __________

Position ________________ Level _________ Organization ___________________ Year __________

Position ________________ Level _________ Organization ___________________ Year __________

 

Training: Certification Level   1   2   3   4                    ID # ______________ Date Issued ______________

Have you filled out a USA Screening form?   Y   N       Year _____________

Are you: First Aid certified? _________ CPR Certified? _________

 

Name __________________________________ Phone _____________

Name __________________________________ Phone _____________

 

Selection of Coaches requires acceptance of Webster Youth Hockey Policies.

Selected coaches may be required to submit background information to USA Hockey.

Final selection of teams is subject to change based upon player availability.

 

Signature ________________________________ Date ______________

 

Please Note: All Coaches and Assistant coaches must be certified at the appropriate level as determined by USA Hockey.

 

Please return applications to:                        Questions?  

Rick Bauer                                                     Michele Thompson    585-787-2633

116 Guygrace Lane                                       Gini Weslowski    585-218-5256                   

Webster, NY 14580                          

                                   

Interviews will be required for all applicants. Any additional information relevant to your application, please attach to the application or use back side of this form.      

 

 

 

 

 

Webster Girls Program:   http://webstergirlshockey.tripod.com/