<p> North Dundas Minor Hockey Association</p><p>Head Coaching Application Form 2017-2018 Season</p><p>Email: [email protected] Mail: Coach Selection Committee c/o Barb Menard, 537 Fred Street, Winchester Ontario, K0C 2K0</p><p>Name: </p><p>Telephone: ______</p><p>Email: ______</p><p>I am interested in a position as:</p><p> o Head Coach: Deadline for Head Coach Applications is AUGUST 25, 2017</p><p>Undertaking:</p><p>1) I hereby consent to disclosure of the above information.</p><p>2) I hereby acknowledge the authority of Hockey Canada, Branch, District, and North Dundas Minor Hockey and agree to carry out and abide by the constitutions, bylaws, rules and regulations. 3) I hereby acknowledge that I have read and understand the coach’s role as outlined in the “Coaches Code of Conduct”. (Coaches Only) 4) I hereby agree to familiarize myself with the National Coaching Certification Program (NCCP) requirements for coaching minor hockey and ensure that I maintain the required level of certification. (Coaches Only) 5) By way of this application, I give permission to North Dundas Minor Hockey Association to pursue a criminal record search on myself and understand that I will be subjected to screening as designated by my position.</p><p>Signature: Date: </p><p>References: Please list two references that may be contacted who are familiar with your hockey involvement</p><p>Reference Phone Number Relationship/Position 1.</p><p>2.</p><p>COACHES ONLY REQUIRED TO FILL THE REMAINDER OF APPLICATION</p><p>Please indicate your preference with respect to team (please indicate by 1st or 2nd choice if applicable)(subject to change, as teams are declared by ND in August) Division Level (Rep or House League) Novice o B Rep o B House o C House Atom o B Rep o B House o C House PeeWee o B Rep o B House o C House Bantam o B Rep o B House o C House Major Midget o B Rep o B House o C House</p><p>Certification:</p><p>Course/Certification Year Completed Qualifying Level Respect in Sport</p><p>NCCP (level) Coach 2/ Dev. 1</p><p>Other Coaching Courses or Training:</p><p>**Applicants not in possession of an NCCP level will be required to attend a Coaches Clinic as applicable. Clinic fees will be paid by NDMHA.</p><p>Previous Coaching/Trainer Experience/Manager: (use a separate sheet if necessary)</p><p>Team/Level Organization Position Year</p><p>Briefly describe your Coaching Philosophy:</p><p> If a Coaching position were not available in the division/level of your choice would you be willing to coach in another division? </p><p> o Yes</p><p> o No</p><p> If you are not certified at the required level, are you available to take a weekend course to attain the required level?</p><p> o Yes</p><p> o No</p><p>Thank you,</p><p>North Dundas Minor Hockey Association </p>