CLA Form 100B
Effective January 1, 2016
It is mandatory that the Associations or Clubs have this form completed and returned to the BCLA Office
st
th
by May 1
for Minors and May 15
for Seniors in the current playing year.
Club or Association Name:
b
Division and Calibre:
Year of Current Season:
The Head Coach of the above team is required to sign this form on the reverse side and is responsible to ensure that the appropriate certification level(s) as
outlined in the NCCP (see reverse side) are met by his/her coaching staff in order to coach a lacrosse team registered with a
Member Association of the CLA.
Coaching Staff Registration
Head Coach
Assistant Coach
Assistant Coach
Assistant Coach
Name:
Address:
City:
Postal Code:
Phone Number:
E-Mail Address:
NCCP #:
Police Check
(If Required)
Date of Birth
(MM/DD/YYYY):
lease note that any Door Personnel PeeWee to Senior, must have the Community Development – Level 1 Coaching Course.
P
Door Personnel Registration
Name:
Address:
Phone #:
E-Mail:
NCCP#/BCLA#:
Door Person:
Door Person:
Door Person:
Door Person:
Bench Personnel Registration
Name:
Address:
Phone #:
E-Mail:
Manager:
Equip. Manager
Other:
Please submit the $10.00/person registration fee for each coach listed above and $5.00 for the Trainer listed below payable to the BCLA
along with this form. Coaches and Trainers are not considered registered until registration fees are paid.
Trainer Registration
Name:
Address:
Phone #:
E-Mail:
Certification:
Trainer
Please Note:
1. Team Head Coaches are responsible for the conduct of ALL personnel.
2. Rules stipulate that only four of the above registered coaches can occupy the Coaches Area.
Important – See reverse for Coach and Trainer Certification Program Minimum Standards
#101 – 7382 Winston Street, Burnaby BC V5A 2G9 PH: (604) 421-9755 ext 1 FAX: (604) 421-9775
Website:
E-Mail: