cctp enrolment form 7th 9th april 2014

8/12/2019 CCTP Enrolment Form 7th 9th April 2014

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________________

Community Coach Training Enrolment Form

7th& 9thApril 2014

Course Date: 7th& 9thApril 2014 Course Time: 4pm-8pmCourse Venue: St John Fisher Primary, Hicks Lane, Tumbi Umbi

TITLE: (Please circle) Mr Mrs Miss

FIRST NAME: __________________________ LAST NAME:______________________________

DATE OF BIRTH: __________________________ GENDER (Please circle) M / F

TELEPHONE: (W) ____________________ (H) ______________________________________

TELEPHONE: (M) _______________________________ FAX:__________________________

EMAIL ADDRESS: _____________________________________________________________

POSTAL ADDRESS: ___________________________________________________________

ACTUAL ADDRESS: ___________________________________________________________

TOWN/SUBURB: _____________________ __________ POSTCODE: ___________________

ARE YOU OF ABORIGINAL OR TORRES STRAIT ISLANDER (TSI) ORIGIN?

NO ABORIGINAL TSI DO YOU HAVE A SIGNIFICANT DISABILITY OR LONG TERM MEDICAL CONDITION? YES / NO

IF YES, WHAT IS THE NATURE OF YOUR DISABILITY? ____________________

__________________________________________________________________

ARE YOU FROM A NON-ENGLISH SPEAKING BACKGROUND (NESB)? YES / NO

IF YES, PLEASE SPECIFY: ____________________________________________ ____

ARE YOU: An internal deliverer from a AASC school or OSHCS (i.e. employee or enrolled student of a

AASC School or OSHCS)

Representing an Organisation (e.g. sporting club or local council) An individual deliverer whether paid or volunteer, not representing an organisation

If representing an organisation or School/OSHCS, please list the organisation name: __________________

PERSONAL DETAILS

OPTIONAL

WHICH ONE OF THE FOLLOWING APPLIES TO YOU?


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Tick which of the following applies to you:

NSO, SSO, Regional Sporting body Community member

Student Private Provider

Local Club Member Local Government

Other (please Specify) ___________________________________________

Have you completed any of the following qualifications (please attach evidence of completion):

Teaching qualifications or currently in 4thyear (primary orsecondary)

NCAS Beginning Coaching General Principles (or NCASentry level coaching accreditation)

Certificate III in Childcare or above

MEDICAL CONDITIONS

PERSON TO CONTACT IN CASE OF EMERGENCY:

NAME: __________________________________ PHONE: _______________________

The course may involve physical activities, some of which may require a reasonable level of fitness. Arethere any known reasons: illness, disability, impairment or otherwise, which may impact, limit or restrictyour participation in the course?

NO YES If Yes please specify:

__________________________________________________________________

__________________________________________________________________

APPLICANTS RELEASE AND ACCEPTANCE

I declare the above information is true and correct. I authorise The Australian Sports Commissionpersonnel to obtain medical assistance that they deem necessary should any medical problem oraccident occur, and I agree to pay all medical expenses incurred on my behalf.

I agree to release the ASC from any liability to me for any injury or illness that I may suffer, and for anyloss or damage to property in connection with the course, except where that liability arises as a result ofnegligence of the ASC.

The ASC collects personal information in the course of administering the AASC and this enrolmentprocess. In order to administer the AASC, the ASC may disclose the personal details provided on this

form to schools/OSHCS who are seeking to engage a person to deliver structured physical activities.

SIGNATURE: ____________________________________ DATE: ________________

UNDER 18 (PARENT OR LEGAL GUARDIAN TO COMPLETE)

As the parent/legal guardian of ______________________________ ________________ I give consentto his/her participation in the Australian Sports Commission Community Coach Training for which he/shehas enrolled and agree to the release and acceptance information stated above.

NAME: __________________________________ _____________________________

SIGNATURE:______________________________________ DATE: _______________________


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The New Working with Children Check

From 15 June 2013 the NSW Commission for Children and Young People will commence anew Working With Children Check in NSW. If you wish to coach in the Active After-schoolcommunities program you will need to complete the new working with Children Checkprocess. If you are a new coach commencing in the program you will need to complete thebelow process prior to attending or enrolling in a Community Coach Training Course. Onceyou have your new Working With Children Check number you will need to supply this to theRegional Coordinator coordinating the course.

Under the new check:

workers and volunteers will apply for their own check once every five years employers will verify a child-related worker's or volunteer's clearance number the same Working With Children Check will apply to everyonepaid workers, self-

employed people and volunteers everyone with a clearance will be continuously monitored for serious sex or violence

offences.

There can only be two results for a new Working With Children Checka clearance or a bar.

People with a bar may not work or volunteer in child-related roles.

Cost: The new check will be free for volunteers and cost $80 for paid workers and self-employed people. A volunteer check cannot be used for paid work with children.

A person with a volunteer clearance will be able to work in paid child-related roles as long asthe $80 fee is paid within 30 days of starting the paid work.

There will be a simple two-step process for getting a new Working With Children Check:

1. Fill in an online formhttp://www.kids.nsw.gov.au/kids/working/newcheck.cfm

or call the helpline 9286 7276 to have someone fill in a form for you2. Take the application number to amotor registryorgovernment access centre,pay the

fee (if applicable) and have your identity confirmed (you will need to takeappropriateidentificationwith you).

Once you have been cleared through the check you will receive an email or letter in the postconfirming your new number.

Find out more:http://www.kids.nsw.gov.au/kids/working/newcheck.cfmNSW Commission for Children and Young People
http://www.kids.nsw.gov.au/kids/working/newcheck.cfmhttp://www.kids.nsw.gov.au/kids/working/newcheck.cfmhttp://www.kids.nsw.gov.au/kids/working/newcheck.cfmhttp://www.rta.nsw.gov.au/cgi-bin/index.cgi?action=motorregistries.formhttp://www.rta.nsw.gov.au/cgi-bin/index.cgi?action=motorregistries.formhttp://www.rta.nsw.gov.au/cgi-bin/index.cgi?action=motorregistries.formhttp://www.directory.nsw.gov.au/gap.asphttp://www.directory.nsw.gov.au/gap.asphttp://www.directory.nsw.gov.au/gap.asphttp://www.rta.nsw.gov.au/licensing/proofidentity/index.htmlhttp://www.rta.nsw.gov.au/licensing/proofidentity/index.htmlhttp://www.rta.nsw.gov.au/licensing/proofidentity/index.htmlhttp://www.rta.nsw.gov.au/licensing/proofidentity/index.htmlhttp://www.kids.nsw.gov.au/kids/working/newcheck.cfmhttp://www.kids.nsw.gov.au/kids/working/newcheck.cfmhttp://www.kids.nsw.gov.au/kids/working/newcheck.cfmhttp://www.kids.nsw.gov.au/kids/working/newcheck.cfmhttp://www.rta.nsw.gov.au/licensing/proofidentity/index.htmlhttp://www.rta.nsw.gov.au/licensing/proofidentity/index.htmlhttp://www.directory.nsw.gov.au/gap.asphttp://www.rta.nsw.gov.au/cgi-bin/index.cgi?action=motorregistries.formhttp://www.kids.nsw.gov.au/kids/working/newcheck.cfm

cctp enrolment form 7th 9th april 2014

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