Trainer Update-Renewal-Crossover Form (Minor Hockey Alliance of Ontario)

Trainer Update-Renewal-Crossover Form

Please complete the application below in full.

PART A: Contact Information

Please complete in full.

Full Name:^*

Required

First & Last

Mailing Address:^*

Required

Email Address:^*

Required

Example: [email protected]. Your submission will be sent to this address.

Date of Birth

Allows us to narrow the search for your participant profile

Phone #:

We may need to contact you for further information.

Certification Number:

i.e. 22-TK2-12345

HCR #:

i.e. HCR 1700004329237

Part B - Payment Section

Fee is $8.00 for any renewal/upgrade, crossover or replacement card request. Visa or MasterCard only. **A payment receipt will be forwarded to the email address submitted on this form.

Visa or MasterCard:

VISAMasterCard

Credit Card Number:

i.e. 1111 2222 3333 4444

Credit Card expiry date:

i.e. 12/24

Name on Credit Card:

By submitting this request, I authorize ALLIANCE Hockey to bill my credit card for the update/renewal request.^*

YES

Required

Part C - Previous/Current Certifications

Please attach copies of your current Standard First Aid certificate if you are requesting a Trainer Upgrade.

Attach Standard First Aid certificate

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 1. Maximum File Size: 4MB.

Thank you for submitting your request.

Upon receipt, ALLIANCE Hockey will:

1. Process your request and post mail your updated certification (please allow up to 10 days for delivery)

OR

2. If there are any issues, we will contact you directly.

If you have any questions, please contact Zach Mark: [email protected].

I agree to the terms and conditions stated above^*

Trainer Update-Renewal-Crossover Form (Minor Hockey Alliance of Ontario)

AAA

AA-A

BB-B

MD

House League

PART A: Contact Information

Part B - Payment Section

Part C - Previous/Current Certifications