OFFICIALS DIRECT DEPOSIT AUTHORIZATION & CONSENT FORM

This form must be completed by all officials who receive payment from the Moose Jaw Minor Hockey Association (MJMHA). MJMHA collects banking information for the sole purpose of processing payments for officiating services. Banking information will be treated as confidential and accessed only by authorized individuals who require it to process payments.

SECTION 1 — OFFICIAL INFORMATION

SECTION

Officials Name *

Date of Birth *

Email *

Phone Number *

SECTION 2 — OFFICIAL AGE

What is the officials age *

SECTION 3A — PARENT/LEGAL GUARDIAN INFORMATION

For Officials 15 Years of Age or Under

Parent/Legal Guardian Full Name

Relationship to Official

Parent/Guardian Email Address

Parent/Guardian Phone Number

SECTION 3B — OFFICIAL INFORMATION

For Officials 16 Years of Age or Older

Confirm that information in Section 1 is correct

SECTION 4 — BANK ACCOUNT INFORMATION

Name on Bank Account *

Financial Institution *

Transit Number *

Institution Number *

Account Number *

I confirm that the banking information provided is accurate and authorize Moose Jaw Minor Hockey Association to deposit payments owed to me for officiating services into the bank account provided above. *

Required Checkbox

SECTION 5 — BANKING INFORMATION ACKNOWLEDGEMENT

I understand that I am responsible for ensuring the banking information provided to MJMHA is accurate and up to date. I will notify MJMHA if my banking information changes. I understand that MJMHA is not responsible for payment delays or Required Checkbox *

Required Checkbox

SECTION 6 — PRIVACY ACKNOWLEDGEMENT

I understand that the banking information collected through this form will be used for the purpose of processing payments for officiating services and related accounting and record-keeping requirements. MJMHA will make reasonable efforts to protect the co *

Required Checkbox

Please verify that you are a human.