Wausau Youth Hockey

Name (First, Last)*

Email*

Address*

City*

Zip Code*

Date of Birth*

Cell Phone*

Level Interested in Coaching*

Head or Asst Coach*

Head

Asst

2nd Level Interested in Coaching

Head or Asst Coach

Head

Asst

Skater playing in Wausau Hockey*

Skater's name(s)

USA Hockey CEP Level*

Age Specific Modules*

USA Hockey Certification Number

Expiration Date

Coaching/Playing Experience*

Philosophy of Coaching*

Read and Sign Below* By accepting a coaching role, you acknowledge and agree that any DIBS credits awarded are contingent upon meeting the minimum coaching requirements. Failure to meet these standards may result in the revocation of DIBS. Minimum requirements include, but are not limited to: Securing all required USA Hockey certifications, attending at least 75% of practices and games, Upholding Wausau Youth Hockey values, serving as a positive role model for skaters and families—both at home events and when visiting other associations. Your commitment helps foster a supportive, respectful, and growth-oriented environment for all participants

Please Read and SIGN Below* Wausau Youth Hockey will not authorize or sanction in any of its programs that it directly controls any volunteer or employee who has routine access to kids who refuses to consent to be screened by Wausau Youth Hockey. I hereby certify that all of the information I have provided in this application is true and accurate and can be used for the purpose of screening or background check. I understand that any false or misleading statements I provide may be cause for Wausau Youth Hockey to refuse acceptance of this application. I HEREBY WAIVE, RELEASE, AND DISCHARGE Wausau Youth Hockey, its employees and individuals, and any other person or entity from all liability and damages, except liability for willful or intentional acts, that may result from compliance or attempts to comply with this authorization. Type your name as agreeing to these terms.

Coaching Application

Confirmation

Mite

10U

10U Girls

12U

12U Girls

14U

14U Girls

Other

For Parents

For Coaches

For Team Managers

For Officials

Coaching Application

Confirmation