Coaching Application

Please submit this form by the end of tryouts to be considering for a coaching position.

Name (First, Last)*

Email*

Address*

City*

Zip Code*

Date of Birth*

Cell Phone*

Level Interested in Coaching*

Head or Asst Coach*

Head

Asst

2nd Level Interested in Coaching

Head or Asst Coach

Head

Asst

Skater playing in Wausau Hockey*

Skater's name(s)

USA Hockey CEP Level*

Age Specific Modules*

USA Hockey Certification Number

Expiration Date

Coaching/Playing Experience*

Philosophy of Coaching*

Please Read and SIGN Below* Wausau Youth Hockey will not authorize or sanction in any of its programs that it directly controls any volunteer or employee who has routine access to kids who refuses to consent to be screened by Wausau Youth Hockey. I hereby certify that all of the information I have provided in this application is true and accurate and can be used for the purpose of screening or background check. I understand that any false or misleading statements I provide may be cause for Wausau Youth Hockey to refuse acceptance of this application. I HEREBY WAIVE, RELEASE, AND DISCHARGE Wausau Youth Hockey, its employees and individuals, and any other person or entity from all liability and damages, except liability for willful or intentional acts, that may result from compliance or attempts to comply with this authorization. Type your name as agreeing to these terms.

Mite

10U

12U

Mini Mite

14U

For Parents

For Coaches

For Team Managers

For Officials

Coaching Application

Confirmation