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Details

2024 Junior State Championships - Metro Zone Coach Nominations

TBC, No fixed Address

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Are you attending this event?

Yes No

Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

DOB*

Email Address*

Contact Number*

Club/Association*

Emergency Contact Details

Please provide an emergency contact name*

Please provide an emergency contact mobile number*

Please provide an emergency contact email address*

Zone & Team Preferences

Which Zone would you like to Coach in?*

Which team is your first preference?*

Which team is your second preference?*

Which team is your third preference?*

Are you applying to be a Head Coach or Assistant Coach?

If unsuccessful in your preferred Zone, would you be interested in coaching in another Zone?*

If you answered yes to the above questions, please indicate which Zones. If you answered no, then please type N/A.

Medical Conditions

Please list if you suffer from any medical conditions that your Zone should be aware of*

Please list any allergies or special dietary requirements you may have*

Coaching History & Accreditation

Current Coaching Accreditation Level:*

Please provide a brief outline of your previous coaching experience (100 words or fewer)* Max. 255 characters

Bank Details for Gratuity Payment

Account Name*

BSB*

Account Number*

Working with Children Check (only required if 18 years or older)

Working with Children Check or VIT number*

Working with Children Check or VIT expiry date*

Please upload a picture (or word doc with a picture in it) of your WWCC or VIT card*

Choose file...

Max 5MB

Statement by Supplier Form Upload

Please upload a completed copy of a Statement by Supplier Form (to allow us to make the Gratuity Payment). The link to obtain the form is in the description section above.*

Choose file...

Max 5MB

Event Waiver

If the coach is under 18 years of age, a parent/guardian must read this information with you and agree on your behalf to abide by all items set out below.

By completing this nomination, you are agreeing to abide by Hockey Victoria's codes of behaviours and policies including (but not limited to) the following:

COACH AGREEMENT

1. Myself and my parent/guardian hereby agree that I will:

(a) Coach in a sporting manner, in any hockey game at the Championships in which the team participates.
(b) Punctually attend all practice and training sessions, meetings or other events as required
(c) Notify other team & zone officials in advance if, for any reason, I am unable to attend any team session. I understand that failure to advise team officials of non-attendance may result in disciplinary action.
(d) Carry out, to the best of my ability, all directions and instructions given by the Zone Coordinator
(e) Try to coach to the best of my ability at all times and encourage players to plays to play to the best of their abilities at all times.
(f) Notify HV/Zone Coordinator of any prescription or non-prescription drug that I am currently taking.
(g) Represent HV and my Zone with decorum whilst a team member, and not do anything which may prejudice the best interest of HV or my Zone.
(h) Abide by the Hockey Victoria's Code of Conduct.
(i) Not attend any game, training or other team session or event in a condition affected by alcohol or other substances.
(j) Not partake in any of the following behaviours, drinking alcohol / smoking / e-Cigarettes / consumption of illicit substances or other non sanctioned behaviours during the time I am representing my Zone.

2. Myself and my parent/guardian understand that if I am found to be in breach of this agreement, then the Zone Coordinator and/or HV may take disciplinary action.

Such disciplinary action may include:
(a) Dismissal from the Zone Team.
(b) Suspension from the Zone Team.
(c) Exclusions from participating in future Zone teams.
(d) Any other action which the Zone Coordinator and/or Hockey Victoria considers reasonable.

Myself and my parent/guardian understand that should my behaviour be deemed by the Zone Coordinator and/or Hockey Victoria to be such that my continued participation is no longer desired, I will no longer be entitled to the full gratuity payment and I may only receive a portion of the payment.

3. Myself and my parent/guardian cknowledge that HV is not responsible for payment of any medical expenses incurred by me.

4. Myself and my parent/guardian accept the inherent risks of injury associated with hockey and agree to assume such a risk.

5. Myself and my parent/guardian acknowledge that HV has no liability in relation to any injury sustained by me whilst a Zone representative under this agreement.

6. Myself and my parent/guardian hereby agree to indemnify HV and any HV official, in respect of all actions, claims, demands, losses and expenses incurred or suffered by HV arising from an action, injury or illness suffered or incurred by me.

7. Myself and my parent/guardian authorize the Team Officials and/or Zone Coordinator and/or HV to seek and provide on my behalf and at my expense, any medical treatment that is deemed necessary.

CONSENT

I/my parent or guardian understand that the Event will be conducted in accordance with Hockey Victoria's guidelines. I authroise any official from Hockey Victoria, in the event of any injury or illness, to obtain on my behalf and at my expense any medical assistance, treatment and transportation deemed necessary.

INDEMNITY

Except where provided or required by law and such cannot be excluded, I/my parent or guardian agree that Hockey Victoria, and it's respective directors, officers, members, servants and agents are absolved from all liability arising from injury or damage to me, however caused, arising whilst participating in the Event.

The terms of this agreement will be deemed to have commenced as at the date of this agreement, and shall expire upon the conclusion of the Junior State Championships I am participating in.

Myself and my parent/guardian have read, understood and agree to the above terms. I warrant that all information provided is true and correct.

I confirm that I have read the above Event Waiver in its entirety.*

I agree to the Event Waiver.*

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*