Pueblo Youth Hockey Association by CBtKR7

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									              PYHA Hockey Coach Application
                       2012-2013

Name: __________________________             Home Phone: ________________________
Address: ________________________            Mobile Phone: ______________________
         ________________________            E-Mail address: ______________________
         ________________________            Date of Birth: _______________________


Please circle your responses.
   o What level do you wish to coach?
       Ages 8 & under         Squirt         PeeWee      Bantam       Midget
   o Are you willing to be a Head Coach?           Yes   No
   o Are you willing to be an Assistant?           Yes   No
   o Are you willing to undergo a criminal background check? Yes      No


List your USA Hockey Education Card Number.
What is your current USA Hockey Education Level?
Date of Validation at current education level?



Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Please return completed application to:

Daren Root, On-Ice Director
Pueblo Youth Hockey Association
P.O. Box 757
Pueblo, CO 81002
719-369-0575 (cell)
darenroot@riceroot.com

								
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