Coach Reimbursement (Northumberland Minor Hockey)

Coach Reimbursement

This form is for all Northumberland Minor Hockey REP, House League and Select bench and on-ice helpers 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 **** ***This form can also be used to submit for an NMHA Coach/Trainer ON ICE Blue/Black Suit - receipt from Sommervilles is requied and can be uploaded on this form.***

REQUIRED ITEMS:

Coaches: Coach certification, Respect In Sport Activity Leader, Gender Identity and Expression Course, 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, Gender Identity and Expression Course, Valid Police check/Declaration

Managers: Respect In Sport Activity Leader, Gender Identity and Expression Course, Valid Police check/Declaration

On-ice Volunteer: Respect In Sport Activity Leader, Valid Police check/Declaration
(for practices only....you may not participate on the bench during a game)

OMHA Site: Coaches
OMHA Site: Trainers

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^*

Position on Team^*

Coach, Trainer, Manager

Clinic or Warm-up Suit Purchase Information

Enter Information for the clinic attended and/or Date of Warm-up Suit purchase from Sommerviles (receipt must be submitted)

Type^*

Police check, Trainer, Coach, Respect In Sport, Warm-Up Suit Purchase

Fee^*

Enter the amount of the fee for this certification

Clinic Location^*

Clinic Date/Date of Purchase^*

Attachment

Receipt & Certification Attachments, this can include your receipt for the NMHA Warm-up Suit for Coaches/Trainers ***Anyone using this form for the Warm-Up Suit Reimbursement - attach the receipt from Sommervilles to both the receipt and certificate section and then the form will work***

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.
Maximum # Files: 5. Maximum File Size: 4MB.

Coach Reimbursement (Northumberland Minor Hockey)

OMHA Digital Network

Contact Information

Team Information

Clinic or Warm-up Suit Purchase Information

Attachment

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