Tri County Saints
Student Coach Application
2006-2007
Last Name________________________ First Name___________________
Address_______________________________________________________
City ________________________________ State ________Zip _________
Phone________________________________
Emergency Contact ________________________ Phone_______________
Current Hockey Team: __________________________________________
Date of Birth _____________________
USA Hockey Registered? ___Yes ___No
Student Coaches must:
 Be USA hockey registered
 Fully Equipped on the Ice
 Coach minimum of 1 level down
 Complete this form and have it on file with Board
I, ________________________, Parent or guardian of _________________________
Release the Southeastern Youth Hockey Association (Known as Tri County Saints), its
officers, directors and representatives from all liability resulting from or due to
participation in the Tri County Saints programs. My dependant agrees to abide by the
policies, regulations, bylaws of the Tri County Saints and Mass Hockey; USA Hockey
Code of Conduct and USA Hockey Coaching Code of Ethics. I further understand that if
my dependant conducts him/herself in a manner to be deemed a detriment to the welfare,
safety, sportsmanship, or fair play embodied within the ideals of Tri County Saints, my
dependant can be removed from Student Coaching at any time.
Signed __________________________________________ Date ________________
Parent or Guardian
Signed __________________________________________ Date_________________
Student Coach