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