NAME:______________________________________________________________

ADDRESS:___________________________________________________________

___________________________________________________________________

TELEPHONE (H):________________________(W):__________________________

1. I am interested in coaching in the TCIA Spring Youth program at the following level: ________COACH ________ASST. COACH ________MANAGER

2. I am interested in coaching the following age group(s):

_____Developmental                         _____PeeWee

_____Mite                                          _____Bantam

_____Squirt                                       _____Midget

3. Coaching experience (please list where, when, and which sports):

___________________________________________________________________

______________________________________________________________________________________________________________________________________

4. USA Hockey Coaching Achievement Program (check all that apply):

Date Issued ID#

Associate ___________ _____________

Intermediate ___________ _____________

Advance ___________ _____________

Master ___________ _____________

5. Please add any other comments you may have regarding your desires to be a coach for the TCIA Spring Youth Hockey League.

_________________________________________________________________________________________________________________________________________________________________________________________________________

PLEASE RETURN APPLICATION ASAP TO:

THOMAS CREEK ICE ARENA
80 LYNDON ROAD
FAIRPORT, NY 14450
ATTN: BILL LUKASZONAS
OR
DROP OFF AT THE FRONT DESK