NATIONAL REGISTRY OF COACHES
Membership Renewal Form
PERSONAL PARTICULARS
Name: / Date of Birth:(DDMMYYYY)
NRIC/FIN: / Nationality:
Address:
Postal Code:
Email address:
Contact number: / (M) / (H) / (O)
Occupation: / Gender: / Race:
Highest educational qualification:
Sport: / Current Membership Expiry:
(DDMMYYYY)
SUPPORTING DOCUMENTS FOR RENEWAL
First Aid & AED / Training Centre:
Date of Issue: (DDMMYYYY) / Date of Expiry: (DDMMYYYY)
Continuing Coach / NROC Coach Level / Education (hours) / Practice (hours) / Total CCE Hours
Requirement : / Coach / 15 / 15 / 30
Senior Coach / 24 / 36 / 60
Master Coach / 30 / 70 / 100
Coaches are required to attach their logbook based on the above requirements.
COACH’S PROFILE^#
^Please noted that the below information will be listed on the NROC Coaches’ website for the general public, by submitting this form, you consent to your particulars being listed.
#Please tick accordingly
Coaching status: / Full-time / Part-time / Volunteer
Coaching preference: / Group / Individual
Coaching experience: / years
Preferred coaching zone:
The coaching zones are demarcated in accordance to the Community Development Councils (CDC) districts.
/ South West· Bukit Batok SC
· Bukit Gombak SRC
· Choa Chu Kang SRC
· Clementi SRC
· Jurong Stadium
· Jurong East SRC
· Jurong West SRC
/ South East· Bedok SRC
· Geylang East SC
· Kallang Basin SC
· Katong SC
· Kallang SRC
· National Stadium
/ Central· Ang Mo Kio SC
· Bishan SRC
· Burghley SRC
· Farrer Park TC
· Jalan Besar SRC
· Serangoon SRC
· Toa Payoh SRC
· Lower Delta SRC
· Marina South Fields
· Queenstown SRC
· School of Physical Education SRC
· Tanglin Fields
· Wilfrid SRC
· Yio Chu Kang SRC
/ North West· Woodlands SRC
· Yishun SRC
· Bukit Pankang SC
/ North East· Hougang SRC
· Tampines SRC
· Sengkang SRC
Coaching levels:
/ Recreational / Participative / National Youth Competitions (E.g. Div A)/ Sports Education Programme (SEP) / Major Games (E.g. SEA Games)
/ Overseas Competitions (E.g. World Uni Games)
Specific sport disciplines:
/ N/A/ (e.g. Sprint, etc.)
COACH’S DECLARATION AND UNDERTAKING
Questions / Please indicate as “Yes” or “No” / Remarks
If the answer to any of the questions is “Yes”, please give details
1. Have you ever suffered, or are you currently suffering, from any medical condition, disease, physical or mental illness / impairment?
2. Have you ever been charged with / convicted of, or are you currently being charged with, any offence in a court of law in Singapore or in any other country (even if the outcome is pending or unknown)?
3. Have you ever received any complaints or been disciplined in relation to your professional service, or are you currently facing any disciplinary proceedings by any sporting / professional body, in Singapore or in any other country?
4. Have you ever been suspended, discharged or dismissed from
(a) the service of SportSG or a National Sports Association, or
(b) any sports related employment in Singapore or in any other country?
5. Have you been or are you under any financial embarrassment i.e. you
(a) are an undischarged bankrupt,
(b) are a judgement debtor,
(c) have unsecured debts and liabilities totalling more than 3 months of your last drawn pay, and/or
(d) have signed a promissory note or an acknowledgement of indebtedness?
I hereby further declare that all information provided by me and/or contained in the documents submitted by me in connection with my application are true and correct in all respects. I hereby authorise SportSG to seek verification with the relevant authorities and/or organisations to all information provided in this application as necessary.
I hereby undertake and agree to promptly notify SportSG and/or NSA should any information furnished in this Declaration and Application Form prove to be incorrect or untrue in any respect after the date of this Declaration. In the absence of such notification, SportSG and/or NSA are entitled to assume that the information hereby furnished is true and correct and remains unchanged.
I hereby declare that I have read and understood and agree to the terms, conditions, rules, procedures, guidelines, code and all other provisions in the NROC Handbook (including, without limitation, the Coach's Code of Ethics and Disciplinary Guidelines) and that this application has been made in accordance with and subject to the aforementioned terms, conditions, rules, procedures, guidelines, code and provisions.
I hereby irrevocably undertake and agree to comply with the terms, conditions, rules, procedures, guidelines, code and as set out in the NROC Handbook, and as be amended from time to time at the sole discretion of SportSG (including, without limitation, the Coach's Code of Ethics and Disciplinary Guidelines), and acknowledge and agree that:
a. SportSG and/or NSA shall have no liability in contract, tort or otherwise for any Loss arising directly or indirectly out of, resulting from or in connection with the provision of the coaching services (“Services”) by me or their use by any person. “Loss” means any claim, liability (civil or criminal), damage, injury, death, demand, expense, fee, fine, payment, proceeding, loss (including loss of profit, any indirect, special or consequential loss), compensation and/or penalty of any kind;
b. No condition, warranty or representation of any kind has been or is made by SportSG and/or NSA or any other person on my behalf (whether authorised or not), express or implied, whether arising by law or otherwise in relation to the Services. The conditions, warranties and representations referred to in this clause (b) include any conditions, warranties and representations relating to the description, quality, adequacy, suitability or fitness for any purpose, value, condition, design, operation, performance or conduct of any kind of the Services;
c. I shall make no statement, representation, or claim and shall give no warranty to any person in respect of any matters mentioned in the NROC Handbook, or for and on behalf of SportSG and/or NSA in relation to any matters mentioned therein save such as are specifically authorised by SportSG and/or NSA; and
d. I shall on demand indemnify SportSG and/or NSA, as the case may be, against any Loss incurred by SportSG and/or NSA, as the case may be, at any time arising out of, resulting from or in connection with the provision of the Services or their use by any person.
e. I acknowledge that SportSG may collect, use and disclose my personal data, as provided in this application as a result of my membership for the purposes of this membership application and the administration of my membership. I further acknowledge that SportSG may share my personal information with trusted third parties:
i. Government agencies (or with non-Government entities which have been authorised to carry out specific Government services) to process any applications I have made or to render a service to me, so as to serve me in a most efficient and effective way, unless such sharing is prohibited by law.
ii. SportSG’s advertising, marketing and promotional agencies to help us deliver and analyze the effectiveness of our advertising campaigns and promotions;
iii. third parties required to deliver a service to me, such as a software provider or application developer;
iv. law enforcement or government authorities where they have followed due legal process to request SportSG to disclose the information;
v. third parties including but not limited to NSAs, other sporting organisations, SportSG’s publicity partners who wish to send me information about their products and services, future opportunities; or
vi. third party providers of services, such as data processing; or
vii. web analytics tool providers, such as Google, so as to allow my data to be searchable and available in the public domain.
I hereby further irrevocably undertake and agree that I shall not in any way use the NROC Logo/Trade Mark without first submitting a Logo Request Form and obtaining SportSG’s approval.
In the event that I am involved with any investigations (criminal or otherwise) by the Singapore Police Force and/or any other relevant authorities, I hereby undertake to inform SportSG of the said investigations in writing within twenty four (24) hours.
Signature: / Date:
Name: / NRIC/FIN:
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