Lakes Area Hockey

First Name*

Last Name*

Email*

Phone Number*

What age group(s) are you interested in coaching? (List all)*

What is your role preference? (Head, Assistant, Mites, Learn to Play)*

Desired Level (Select all that apply)*

Learn to Play

Mini-Mite (6U)

Mite (8U)

Squirt (10U)

PeeWee (12U)

Bantam (14U)

If you do not get selected for the desired level, would you be willing to help coach another team?*

Yes

No

Maybe

List Day/Time Schedule Limitations*

Describe your hockey coaching experience (optional)

Have you coached for LAHA in the last 5 years? (If yes, you can submit application now)*

Yes

No

If you have not coached in LAHA, please provide a list of references.

Please List Association(s), Teams, Years, Position or enter None if no prior experience. Please state if you were a head coach or an assistant coach

Are you USA Hockey Certified (CEP)?

Yes

No

Not Current

Hockey Background Years played, highest level competed at, teams, etc.

2026-2027 Coaching Application