Level 1 Tennis Coaching Assistant Course Oct 2017/ Sept 2018

APPLICATION FORM

LEVEL 1 TENNIS COACHING ASSISTANT COURSE OCT 2017/ SEPT 2018

Candidates applying for the Level 1 Certificate in Coaching Tennis Qualification should complete this form and return it to: Chris Holland. It can also be done on line.

At: The Coach Academy, 189 Blind Lane, Flackwell Heath, Bucks HP10 9LE

Please complete all sections in BLOCK CAPITALS

COURSE DETAILS Start Date ………………………......

Venue …………………………………………Course Number (if known) ………………..

PERSONAL INFORMATION

First Name …………………………………………Surname ……………………………….

Are you 16 years or older when the course starts? Y/N Gender………..……………….

Full Postal Address……………………………………………………………………………

……………………………………………………………………Postcode …………………

Email …………………………………………….BTM No. (see LTA Website)…………………

(Please print clearly as most communication by email)

ULN (Unique Learner Number) …………………………………………………….(if known)

Telephone (H) ………………………. Telephone (M) …………………………………..

Emergency contact name and number ………………………………………………………..

MEDICAL

So that the tutors can accommodate your needs, please indicate if you have any of the following:

Asthma Epilepsy Diabetes

Hearing impairment Dyslexia Use of a wheelchair

Other (please state) ……………………………………………………………………......

If you have an LTA DBS, please state date of issue. If you do not have one please request a Safe Deployment Letter from Chris Holland. This needs to be signed by club committee member or coach and returned.

1ST4SPORT QUALIFICATIONS -THE AWARDING BODY FOR ACTIVE LEARNING AND LEISURE

ADDITIONAL INFORMATION

What experience do you have working with children?

e.g. I am a parent, helped at my tennis club, have helped in another sport.

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

What experience do you have playing tennis?

e.g. I played at school, I play at my club, I don’t really play.

What other coaching qualifications/experience do you have that will help you on the course?

e.g. I am a teacher, I have other coaching qualifications.

Is there anything else you would like the tutors to know before the course?

Which venue will you be assisting at and who is the lead coach you will be working with?

(you need to work with a Licensed Coach as a mentor for a minimum of 3 hours)

PAYMENT

The full course fee is as follows - £235

Cheques should be made payable to ‘The Coach Academy’ and be enclosed with this application.

ENCLOSE THE FOLLOWING

· Completed and signed application form /OR COMPLETE ONLINE

· Full course fee as outlined above/CAN BE PAID ON LINE

I have already applied for a DBS disclosure through the LTA, and am awaiting its completion

I have already received a DBS disclosure, processed by the LTA. This will be less than 12 months old when I start my course.

I have requested a Safe Deployment Form

Visit www.LTA.org.uk/in-your-area/Buckinghamshire to view a list of Safety & Wellbeing workshops. This is not compulsory, but we recommend candidates attend this 3 hour course (Required for registration)

DATA PROTECTION

The Coach Academy will use your personal data including sensitive personal data for coach education purposes only and to send you, by post or email/SMS, information related to those purposes. For further details please see www.LTA.org.uk/privacy.

APPLICANT’S AGREEMENT

Please put a cross in this box if you agree to the terms and conditions (or signed)

Signed…………………………………………………………………...