COACH FOUNDATION & CPD COURSEAPPLICATION FORM
  1. Please complete this form on a PC: tab between the boxes, and print & sign when complete.
  2. Completed applications should be sentto the RFU Regional Coaching Centre with the appropriate fee.We are unable to accept application forms electronicallywhich include credit card details.
  3. Applications must be received no later than 14 days prior to the start of course unless otherwise specified.
  4. Please complete all boxes – applications will be returned to you if information is incomplete or illegible.

Nature of the Coaching Courses

Attendance on coaching courses will require some practical involvement to assist the coaching process. Please raise any issues that could affect your health with either the administrator, or your Coach Educator on arrival at the course.

  1. You must complete all details so that your RFU RugbyFirst record can be maintained listing all of your qualifications and attendance at training events.

Rugby First ID Number
If known / Home Tel. No.
First name / Surname
Gender / MALEFEMALE / Date of Birth / dd/MM/yyyy
Full Address Postcode
Mobile Telephone No / Ethnicity I would describe my ethnic origin as:. / Please SelectAsian British BangladeshiAsian British IndianAsian British PakistaniBangladeshiBlack AfricanBlack BritishBlack CaribbeanIndianMixed White & AsianMixed White & Black AfricanMixed White & Black CaribbeanOtherOther AsianOther BlackOther WhitePakistaniWhite BritishWhite EuropeanWhite IrishWhite Non European
Email Address - Correspondence for this course & the coaching newsletter will be sent by email
Name & Contact No. in case of emergency:
DisabilityDo you consider yourself to have a disability?
This will help course staff to support your learning needs. / NoneHearingVisualLearningMobilityDyslexiaMultipleOtherIf yes, what is the nature of your disability:
Comment:
2.Course Details - Please complete all boxes
Please select age group of player you are coaching / Please select age/type of player coachingCoaches of AdultsCoaches of Youth (13-18)Coaches of Children (7-12) / Course Start Date(s) / dd/mm/yyyy
Select Course / Please select your courseRugby Leaders Course £20RugbyReady Course - £18Tag Rugby Course - £20The Line-out Game - £15Performance Profiling - £15Scrum - £15Defence in Phase Play -£15Continuity in Attack - £15Maul & Ruck - £15 / Course fee / £
Course Venue / VAT Registered? / NOYES
Payment method / Cheques
Payable to RFD Ltd / Credit / Debit Card Payment Details
Please do not email application forms which include completed Credit Card details – tick the appropriate box and telephone the administrator with your details.
Credit card / Card TypeNoneVisaMC
Debit card / Card TypeNoneMaestroSwitchSolo
  1. Please tick the role(s) that reflect(s) your involvement & give the name of the club / school & CB

Teacher / Student / Name of School
Club Youth Team Coach / U7U8U9U10U11U12U13U14U15U16U17U18 / Other / Name of Club
Club Adult Team Coach / Representative Coach / Please SelectNoneNational CoachNational U20s CoachNational U18s CoachNational U16s CoachDivisional CoachCB Coach (Adult)CB Coach (U20)CB Coach (U14-U18)SoR Coach / Constituent Body (e.g. Leicestershire)
4.Personal Data
The RFU may use your personal data (including potentially sensitive data) for the purposes of considering your application, for regulatory reasons and to send you information. To make your choice as to the categories of commercial information you would wish to receive from the RFU, you should tick or leave blank the relevant boxes below.
Tick here if you do not wish to receive, by electronic mail (including e-mail, SMS or image messages etc) information about tickets, special offers, opportunities, products and services available from RFU companies or RFU subsidiaries.
Tick here if you do not wish to receive, by electronic mail (including e-mail, SMS or image messages etc) information about products and services available from current RFU sponsors.
Tick here if you dowish to receive, by electronic mail (including e-mail, SMS or image messages etc) information about products and services available from any subsidiary or associated company of any RFU sponsor.

I confirm that I have read, understand and agree to the terms and conditions of the coaching course, and authorise payment.

Signed: / Date:

Version: Oct 2009