ACCREDITED ATHLETICS COACH

RE - REGISTRATION – 2017

Please update those sections below where personal information has changed since initial registration.

Title
Surname
First name
Initial
Gender
Address
Suburb
State
Postcode
Country
Phone Home
Phone Work
Phone mobile
Date of Birth
Email Address
Email format / HTML or PLAIN TEXT circle preferred option

Accredited Athletics Coach Registration fee $ 88.00 annual payment

Payment Method

  1. Payment by Cheque: made payable to

Athletics Australia

Athletics House, Level 2, 31 Aughtie Drive, Albert Park,

VIC 3206

  1. Payment by Credit Card

Type of Card Visa / Mastercard

Name______

Card number______

Expiry Date______

Signature ______

The annual Accredited Athletics Coach Registration fee covers:

  1. Recognition as an Accredited Athletics Coach at your current level of accreditation, with the sport and the NCAS.
  2. Insurance, covering your coaching practice appropriate to your level of accreditation for:
  1. Professional Indemnity
  2. Public Liability
  3. Personal Accident
  1. Inclusion on the single national database of Accredited Athletics Coaches, including the ASC’s Sport Accreditation On-Line and the NCAS.
  2. Registration as a coach with your home state Athletic Australia Member Association.

Member statement

I hereby make application for registration as an Accredited Athletics Coach with AthleticsAustralia.

I agree to abide by, and submit myself to the jurisdiction of all the Member Protection Policies, Rules and By-Laws of Athletics Australia and those of its Member Association in the State where I reside, including Memorandums, Articles and By-Laws, general and specific codes of conduct contained therein, and the Constitution and Rules of the International Association of Athletics Federation as amended from time to time.

ACKNOWLEDGEMENT
☐By marking this box I acknowledge that I have read the Member Statement and agree to abide by it.

Print name: ______

Date:

Member Protection Declaration

All Accredited Athletics Coaches are subject to the provisions of the Athletics Australia Member Protection Policies.

Athletics Australia has a duty of care to its members and to the general public who interact with itscoaches. As part of this duty of care and as a requirement of Athletics Australia, Accredited Athletics Coaches need to agree to the following Member Protection Declaration:

I sincerely declare that:

  1. I do not have any criminal charge pending before the courts;
  1. I do not have any criminal convictions or findings of guilt for offences involving dishonesty, sexual activity, acts of indecency, child abuse or child pornography;
  1. I have not had any disciplinary proceedings brought against me by an employer, sporting organisation or similar body involving child abuse, sexual misconduct or harassment, acts of violence, intimidation or other forms of harassment;
  1. I have never been sanctioned for an anti-doping rule violation under any anti-doping policy applicable to me;
  1. I will not participate in, facilitate or encourage any practice prohibited by the World Anti-Doping Agency Code or any other anti-doping policy applicable to me;
  1. To my knowledge there is no other matter that The Company (Athletics Australia), itsassociations or clubsmay consider to constitute a risk to its members, employees, volunteers, athletes or reputation by engaging me as an Accredited Athletics Coach;
  1. I will notify the CEOof the organisation(s) engaging me immediately upon becoming aware of any of the matters set out in clauses 1 to 6 above which have changed for whatever reason;
  1. Agree to provide a Police Check if requested by the governing body

ACKNOWLEDGEMENT
☐By marking this box I acknowledge that I have read the terms of the MPD and declare they are correct in every particular

Print name:

Date:

Child Protection

Children have a fundamental right to be safe from any form of abuse while involved in sport or associated activities. This is a legal requirement as well as a moral obligation. Child protection requires a commitment from all levels in sport to ensure sporting environments are safe for all children. This includes an awareness of the requirements and risks, a commitment to practices that minimise the risks, and the ability to appropriately respond to incidents of child abuse.

Visit the Australian Sports Commission website

Accredited Athletics Coaches are advised to consult further with the specific requirements for Working with Children that are of relevance to the State in which they are coaching.

Play by the Rules is a partnership between the Australian Sports Commission and all State/Territory sport and recreation and anti-discrimination agencies and provides advice on dealing with discrimination, harassment and child abuse for the sport and recreation industry.

The information on Play by the Rules is not intended to be, nor should it be relied upon as, a substitute for legal or other professional advice. Play by the Rules is supported by the Australian and State and Territory Governments.

ACKNOWLEDGEMENT
☐By marking this box I acknowledge that I have read the information relating to Child Protection and acknowledge that I will abide by the Child Protection requirements for Athletics Coaches as they relate in my State of residence.

Print name:

Date:

CODE OF CONDUCT

The Code of Conduct for the Accredited Athletics Coach is adopted from the International Association of Athletics Federations (IAAF), and the Australian Sports Commission (ASC).

The basic principle is that ethical considerations leading to fair play are integral and mandatory elements of coaching Athletics. These ethical considerations apply to all levels of ability and commitment, including recreational and competitive involvement in Athletics.

The full Code of Conduct is available online.

ACKNOWLEDGEMENT
☐By marking this box I acknowledge that I have read the Code of Conduct and agree to abide by all of its terms.

Print Name:

Date:

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