YORKSHIRE NETBALL

LEADERSHIP & COACHING WORKSHOP

BOOKING FORM

When applying for a Yorkshire Netball course please complete ALL information on this booking form:

Workshop Name: / First Step into Leading & Coaching Netball
Cost: £20
Venue : / Bradford College (Trinity Road Campus), Easby Road, Bradford, BD7 1JG
Date: / Wednesday, 1st July 2015
Time: 6.30p.m – 9.30p.m
Candidate Name (Ms/Mr/Miss/Mrs):
Affiliation Number / Netball ID No:
(if applicable)
Candidate Address:
Contact Telephone No: Home:
Mobile:
E-mail address:
Date of Birth:
(Applicants must be 16 years of age)
Emergency Contact Name:
Emergency Contact No:
Medical Information
(e.g epilepsy, asthma, diabetes, allergies etc)

Please list below any Netball or any other sport related awards / qualifications you currently hold:

Awards / Level / Date achieved

Please provide information on your reason for wanting to do this course, i.e. helping at child’s school or club, Back to Netball team support, etc

Please provide brief information on your current knowledge and/or involvement in netball, if any

Are you able to actively take part in the game of Netball?** Yes No

If no, please detail the reason: ………………………………………………………….…

……………………………………………………………………………………….….………

** Please note: For some practical workshops participants may need to be actively involved in netball skills and drills. If you are not able to actively take part, please inform the course organiser at the point of booking.

Payment:

By Cheque or BACS payment only

Cheques must be made payable to ‘Yorkshire Netball’ with the candidates name clearly printed on the back and returned to:

Debbie Chandley, Netball office, E.I.S, Coleridge Road, Sheffield, S9 5DA

BACS payment details:

HSBC, 1 Well Croft, Shipley, West Yorkshire, BD18 3QH

Sort Code: 40-41-44

Account No: 91733486

If paying by BACS please ensure you provide a reference detailing the reason for payment i.e First Steps Netball

Cancellation Policy:

‘Yorkshire Netball’ operate a ‘no refund’ policy.

Requests to cancel a booking should be directed to Debbie Chandley and will be considered on an individual basis.

For monitoring purposes, please can you complete the following additional information. Thank you.

Are you male or female?
Date of Birth
What is your ethnic group?
White / White British / Black or Black British / Black Caribbean 
African 
Other Black 

Mixed

/ White & Black Caribbean o
White & Black African o
White & Asian o
Other Mixed o / Chinese or Other Ethnic Group / Chinese o
Other Ethnic Group o
Asian or Asian British
/ Indian 
Pakistani 
Bangladeshi 
Other Asian  / Prefer not to say / o
Unknown / o

The Disability Discrimination Act 1995 defines a disabled person as anyone with a ‘physical or mental impairment which has a substantial and long-term adverse effect upon his/her ability to carry out normal day to day activities.’

Do you consider yourself to have a disability?
If Yes, what is the nature of your disability?
Visual o / Learning o / Hearing o / Multiple o
Physical o / Other o / Prefer not to say o

Cheque received: Yes ⇩ No ⇩

Place confirmed Yes ⇩ No ⇩