Please complete the following application for submission to our coaching committee. Upon review, you will be contacted by a representative of our organization. Order Number Name * Email Address * Primary Phone No. * Player's City * What Player Group Are Youn Interested in Coaching? * Boys Girld No Preference What Age Group Are You Interested in Coaching? * Jr. Mini U12 Mini U14 Bantam U16 Midget U18 Juvenile No Preference Describe Your Coaching Experience? * Please Provide Some Teams You Have Coached in the Past * Medical Conditions We Should now About? * No Yes If Yes, Record Medical Details Can You List Some Other Coaches You Have Coached/Worked With in the Past Comments Acknowledgement * I acknowledge that all coaches must undergo a Criminal Records Check and consent to a search by the Nova Scotia Child Abuse Registry.