Kitchener Inclusive Hockey > Kitchener Ice Pirates - Volunteer Information Form 2024/25 (Kitchener Minor Hockey)

Kitchener Ice Pirates - Volunteer Information Form 2024/25

Role of Volunteer

ON-ICE HELPER: Require the ability to skate themselves and teach children/ adults with Special Needs the fundamentals of hockey and skating. Also, to assist coaches/ players in performing drills.

Equipment Needed: Helmet, Hockey Gloves, Skates and Hockey Stick.

OFF-ICE HELPER: Require either Organizational Skills, Computer Skills, the ability to Multi-Task and/or Fundraising skills. MUST be able to work well with Children/ Adults with Special Needs as well as their families.

Certifications Required and Reimbursement Information - For Further Information - Click Here

Applicants confirm all information provided is accurate and if selected will adhere to KMHA and Inclusive guidelines and policies

I agree to the terms and conditions stated below^*

Personal Information

Provide Contact Information

First Name^*

Required

Last Name^*

Required

Birthdate^*

Required

MM/DD/YYYY

Email Address^*

Required

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

Phone Number^*

Required

Example: ###-###-####

Home Address^*

Required

Example: 103 Peter St;.

Apt / Unit Number

City^*

Required

Example: Kitchener

Province^*

Required

Example: ON

Postal Code^*

Required

Example: N7C 1B2

Certifications

List Any Hockey and Other Certifications. For links to Required Certifications, see top of application under Volunteer Role.

Respect-In-Sport (16 years or Older)^*

Required

Will be Required to Volunteer. Only Need to Complete Once

Police Check (18 years or Older)^*

Required

Will Be Required to Volunteer and MUST Be Valid Within the Last 2 Years

Gender Identity and Expression (16 or Older) ^*

Required

Will Be Required to Volunteer, Only Need to Complete Once

Coaching Certificate^*

Required

Not Required to Volunteer

Trainers Certificate (Current)^*

Required

Not Required to Volunteer, If Yes, Select the Year Certified

Referee Certificate^*

Required

Not Required to Volunteer

Hockey Time Keeper Experience^*

Required

Not Required to Volunteer

Police Check Declaration

I DECLARE, since the last Criminal Background Check collected by KMHA or the Kitchener Ice Pirates, as the case may be, or since the last Offence Declaration given to me by KMHA, that:

I have no convictions under the Criminal Code of Canada up to and including the date of this declaration for which a pardon has not been issued or granted under the Criminal Records Act (Canada).

I Declare that the above statement is true^*

Police Check Declaration Continued

Please Read Above Statement, Then Complete Section Below. Police Checks are required the first year, then every 3 years.

Dated on ^*

Required

Today's Date

City^*

Required

Example: Kitchener

Provnice^*

Required

Example: ON

Signature^*

Required

Type Name

Other Information

Please Provide As Requested

Started Volunteering With the Ice Pirates^*

Required

Year

Completing High School Volunteer Hours^*

Required

Completing College/ University Volunteer Hours ^*

Required

Volunteering Type^*

Required

Ice Time You Plan To Volunteer At ^*

Fundamentals (12:15)
Junior (1:15)
Intermediate (12:00)
Senior (1:00)

Check ALL That Apply

Are you Interested in Becoming an Ice Pirates Coach in the Future^*

Required

Do you have previous experience working with developmentally delayed children and/or adults? If yes, please explain^*

Required

Medical

I understand that it is my responsibility to keep the team management advised of any change in the below information as soon as possible and that in the event no one can be contacted, team management will take myself/ my child to the hospital/M.D. if deemed necessary.

I hereby authorize the physician and nursing staff to undertake examination, investigation, and necessary treatment of myself/ my child.

I also authorize the release of information to the Ice Pirates Coaches, Staff and appropriate people (Nurses, Paramedics, Physicians, etc.)

If over 18 years of age, I agree to the statement above OR If under 18, Parent/Guardian agrees to the statement above.^*

Medical

Please Read Above Statement, Then Complete Section Below

Are You Over 18^*

Required

If NO, Parent or Guardian's Consent

Parent or Guardian's Full Name

Example: Jane Smith

Parent or Guardian's Phone Number

Example: ###-###-####

Parent or Guardian's Email Address

Example: Jane Smith

Emergency Contact Name^*

Required

Example: Jane Smith

Emergency Contact's Phone Number^*

Required

Example: ###-###-####

Emergency Contact Relationship ^*

Required

Health Concerns ^*

Required

Example: Epileptic, Diabetic, Asthmatic

Allergies^*

Required

Example: Nuts, Latex, Gluten

Do You Have an EpiPen^*

Required

Do You Use an Inhaler^*

Required

Participants Permission for use of Participant's Photo's and/ or Name
Hockey Season: 2022/ 2023 Team Name: Kitchener Ice Pirates - Team GM/ Director: Kirsten Carr

At various times throughout the year, the Ice Pirates and/or Kitchener Minor Hockey may want to use various materials/sites to promote teams’ information, tournaments, and encourage communication through a message board. The team website and Facebook/ Instagram/ Twitter groups/pages are monitored. However the monitor and the Kitchener Minor Hockey Association together assume no responsibility for items posted on the message board and cannot prevent someone from posting a picture of a player or a volunteer onto the Internet. Participants should also understand the Internet can be viewed by anyone, anywhere in the world, thus making the image(s) and names very public. The Ice Pirates and/or Kitchener Minor Hockey occasionally names and photos for authorized marketing purposes, in team brochures and banners, and for other publicity events. The Ice Pirates and/or Kitchener Minor Hockey will also do their best to ensure all names and photos taken are not placed in any unauthorized newspaper or magazine. However, we often do not have control over this and thus do not assume responsibility for any articles or pictures printed.

By Clicking YES below, I give permission for the Kitchener Minor Hockey Association and/or the Kitchener Ice Pirates, to use my name and/or photograph. Volunteer, or Parent/Guardian if under 18, your Clicking YES indicates permission given.

I understand that name and/or image(s) may be posted on the above team’s website and will be linked to the Kitchener Minor Hockey Association website found at www.kitchenerminorhockey.com. The website may also be linked to other relevant hockey sites.

If over 18 years of age, I agree to the statement above OR If under 18, Parent/Guardian agrees to the statement above.

Media Release Form

Please Read Above Statement, Then Complete Section Below

Are You Over !8 ^*

Required

If NO, Parent or Guardian's Consent

Parent or Guardian's Full Name

Example: Jane Smith

Parent or Guardian's Email Address

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

Parent or Guardian's Phone Number

Example: ###-###-####

Internet/ Social Media^*

Required

Permission to Use Photograph and/ or Name

Brochures^*

Required

Permission to Use Photograph and/ or Name

Publicity Events^*

Required

Permission to Use Photograph and/ or Name

Local Magazines/ Newspaper^*

Required

Permission to Use Photograph and/ or Name

Kitchener Ice Pirates - Volunteer Information Form 2024/25, Kitchener Inclusive Hockey (Kitchener Minor Hockey)

Team Websites

Personal Information

Certifications

Police Check Declaration Continued

Other Information

Medical

Media Release Form

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