COURSE APPLICATION FORM

CONFIDENTIAL

If you need to contact us about your application:
Telephone: 01975 641312

www.fitnut.co.uk

About the Course you wish to apply for:

Course Name / Level 2 Award in Instructing Group Indoor Cycling
Entry Requirements
No previous qualifications are needed for this qualification however the YMCA Awards recommends a prerequisite qualification of Level 2 Certificate in Fitness Instructing (QCF) or any qualification within the Physical Activity Advisor category on REPs, for example Level 2 Certificate in Fitness Walking. This qualification does not provide entry to REPs.
Please tell us which prerequisite qualification you have attached with your application.
Dates of course
(please check website for available course dates)
Where did you hear about the course?

About you:

First name / Middle name
Last name
DOB (dd/mm/yyyy) / Gender / M / F
Please tell us how you would like your name to appear on your certificate

Your contact details:

Address
Postcode
Home phone number
Mobile phone number
Your email address

Relevant qualifications and/or membership of professional bodies you may have:

Qualifications (continue on a separate sheet if necessary)
Educational (e.g. GCSE passes); Vocational (e.g. NVQ awarded); Occupational qualification and/or certification held and currently valid (e.g. fork lift truck licence); Professional (e.g. member of the Institute of Personnel and Development). / Date obtained / Awarding Body (e.g. exam board or professional body providing certification).

Do you require any additional learner support? (please tick)

No / Yes / If yes, please indicate below what support would be required

Ethnic Origin (please tick)

White British / Mixed White & Black African
White Irish / Chinese
White Other / Asian or Asian British Indian
Mixed – White & Black Caribbean / Asian or Asian British Pakistani
Mixed - Other / Asian or Asian British Bangladeshi
Black or Black British African / Asian or Asian British - Other
Black or Black British Caribbean / Mixed – White & Asian
Black or Black British Other / Prefer not to say
Your own preferred definition (please indicate)

Data Protection

Fitnut Academy and YMCA adhere to their individual data protection policies; these are available upon request and also on the relevant webpages.

All Course Fees must be paid in full prior to course commencing.

Please tick one of the payment methods below: We will contact you within 48 hours of receiving your completed application form to arrange payment.
Please send me a payment request via PayPal at total cost of £206.80. (No PayPal account required, you can checkout using a valid Credit or Debit Card.) A fee of 3.4% has been added to the total cost of the course to cover the payment processing fee.

Please send me an invoice at total cost of £200 with details of how to make payment through a direct bank transfer or Bacs payment. There is no processing fee for this method of payment. (If the Invoice has to be sent to a company, please provide full details below of who and where this has to be sent).

Contact name, Company Name and full postal address
Email address

Discounts – 10% Discount available for Students, Armed Forces and Charitable Organisations.

I am a Student (Send a copy of your Student Card with the application form)

I am with the Armed Forces (Send a copy of your ID Card with the application form)

I work for a charitable organisation (Send a copy of your ID Badge or a covering letter from your organisation stating you are currently employed by them)

Declaration by applicant

I confirm that to the best of my knowledge the information provided on this form is accurate and complete.

I agree and understand that information will be processed in accordance with the Data Protection Act.

SIGNATURE
NAME
DATE

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