Certificate of Insurance Request (South Simcoe Minor Hockey Association)

Certificate of Insurance Request

Team Name^*

Required

Coach Name^*

Required

Name^*

Required

Position^*

Required

Cell Number^*

Required

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

Email Address:^*

Required

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

Please provide a brief description of what you a requesting the certificate for^*

Required

Start Date^*

Required

End Date^*

Required

Please upload a copy of your permit if you have one:

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

Certificates are not approved until confirmation received from Hockey Canada.

I agree to the terms and conditions stated above^*