Susquehanna Valley Youth Hockey Club

2017–2018 Coaching Application

Name: ______

Address: ______

City, State: ______Zip: ______

Home Phone: ______Cell: ______

Email Address: ______

USA Hockey Coaching Card Number and Season issued:

______

Please check which level(s) you are interested in coaching:

_____ Mite _____ Squirt ______PeeWee _____PeeWee Travel

_____ Bantam _____ Midget ______JV ______Varsity

Please indicate if you have a child playing at the selected level: _____ Yes _____ No

Please indicate which coaching position you are interested in:

_____ Head Coach _____ Assistant Coach _____ Either

If Head Coach, please list up to three names of potential Assistant Coaches you would like to work with:

1 ______

2 ______

3 ______

Coaching Experience: (please detail your coaching experience in all sports)

______

______

______

______

My Coaching Philosophy:

______

______

______

______

Playing Experience:

______

______

What topics would be useful to you, as a youth coach, for us to cover in a coach’s clinic?

______

______

References: (Please list name and phone number for three references)

  1. ______
  1. ______
  1. ______

I certify that the above information is correct and accurate to the best of my knowledge:

Applicant Signature: ______

Date: ______

If we accept your application, pursuant to Pennsylvania law: “On July 1, 2015, the Commonwealth ofPennsylvaniaplaced into law,Act 15of 2015 (which amendedAct153 of 2014) and established various screening and background check requirements for those persons who are "responsible for a child's welfare or have direct and routine contact with children."

As such, before you can take the ice, you will need:

  • Report of criminal history from the Pennsylvania State Police
  • Child Abuse History Certification from the Department of Human Services
  • A fingerprint based federal criminal history (FBI) OR
  • Sworn affidavit (PA resident last 10 years)

Links:

placeholder for child abuse form

New for 2017-2018! The SVYHC has agreed to reimburse coaches for the following USA Hockey requirements:

  • Registration as a member of USA Hockey (required for all coaches)
  • USA Hockey coaching certification clinics levels I - IV (not required as a “Parent Assistant”
  • USA Hockey Safe Sport Training (required every two years for certified coaches, not required as a “Parent Assistant”)
  • USA Hockey online age-specific modules (required for certified coaches, not required as a “Parent Assistant”)

In addition for 2017-2018, as a certifiedcoach in good standing with the SVYHC, we will provide you with a 10% discount from the total expense of your children’s player’s fees and jersey/stockings fees. Does not apply to Parent Assistant Coaches.