The Awarding Body for Active Learning and Leisure

1st4sport Qualifications

the awarding body for active learning and leisure

Application form for the

Level 2Award in Coaching Tennis

Delivered by Growing The Game Ltd

Please complete this form on your computer or print it and complete by hand.

Application forms may be emailed toor posted to the address on page 4 of this form.

APPLICATION FORM

Learners applying for the Level 2Award in Coaching Tennis qualification should complete this form and return it to the course organiser. Please complete all sections clearly in BLOCK CAPITALS.

VENUE

PERSONAL INFORMATION

MEDICAL INFORMATION

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

Asthmayes / noEpilepsyyes / no

Diabetesyes / noHearing impairmentyes / no

Dyslexiayes / noUse of a wheelchair yes / no

Other (please state) ______

CRIMINAL CONVICTIONS

Do you have any criminal convictions, cautions or reprimands?yes/no

(N.B. any convictions, cautions or reprimands, including those that are spent,shouldbe declared)

If yes please state, with date ______

Your applicationmaybe processed more quickly if you attach a separate sheet outlining the nature and circumstances of any convictions/cautions.

ADDITIONAL LEARNER INFORMATION

• Recommendation
• LTA county
• LTA website
• Internet search engine (if so, which one)______
• Facebook/Twitter
• Other (please state)______

• The dates were convenient
• It’s close to where I live, study or work
• The reputation of Growing The Game
• Other (please state):______

HOW TO PAY

The full course fee is £370.00 including VAT.

To pay electronically

By BACS direct to Growing The Game Ltd:

Santander Bank

Sort Code 09-01-28

Account 37061077

PLEASE REFERENCE YOUR PAYMENT CLEARLY WITH THE COURSE CODE OR VENUE/START DATE

To pay by cheque

Cheques should be payable to Growing The Game Ltdand sent toNick Elliott, Growing The Game Ltd,17 Watling Lane, Dorchester on Thames, Wallingford, OX10 75G. Please note that cheques must be received no less than 3 working days before the start of the course.

Payment by third party organisation

Please note that if you are requesting payment in full or in part by a third party, you must read and abide by

Term and Condition 8 on this application form.

Name of organisation______

Name of contact at the organisation______

Email address of contact______

Address of contact

Daytime tel.of contact______

You must providea letter or email from the third party confirming that they agree to meet all or part of your course payment with this application. Failure or delay to do so may mean that you lose your place on the course.

I confirm that the contact above has agreed to pay for part or all of my fee for this course and I enclose written confirmation with this application, with the difference to be paid by me prior to the start of the course (please tick) 

When applying for the course, you must enclose the following:

• completed and signed application form, to be returned to the address shown on page 4
• full course fee of £370.00 including VAT (please tick which applies)

• I am paying by BACS online banking and have referenced my payment (please tick) 
• I am paying by cheque (please tick) 
• A third party is paying for all of my fee. I have completed the required details above and I enclose written confirmation from them that they agree to pay all my course fee (please tick) 
• A third party is paying for part of my fee. I have completed the required details above and I enclose written confirmation from them that they agree to pay part of my course fee. I enclose payment for the remainder of the fee (please tick) 

• A photocopy of your current LTA DBS Enhanced Disclosure(this used to be called CRB and is now called DBS). It must be valid for one year from date of issue.

DECLARATION AND TERMS AND CONDITIONS

I understand and agree that:

1. Growing The Game Ltd is responsible for the administration and delivery of this course.

2. I must attend all the scheduled sessions during the course in the correct sequence and at the agreed venue, to qualify for assessment.

3. If I apply and pay for the course without submitting a photocopy of a valid LTA DBS certificateeither to Growing The Game Ltd or the course tutor by the end of the course, I will not receive certification.

4. If I withdraw from the course less than 21 working days before the start date then the full course fee will be forfeited if the vacancy is not filled. Once I have enrolled onto a course I must attend all 5 days at the same venue. Under no circumstances, other than medical (supported by a doctors note), can I miss parts on the course. If I choose to move to another course, I understand that I am liable for an additional £30 administration fee every time I change courses. I also understand that if I withdraw at any stage during the course I will lose the full course fee.

5. Growing The Game Ltd is not liable for any damage or loss caused under this application process or for the duration of the course save where this is caused by the negligence ofGrowing The Game Ltd, its employees and directly affiliated bodies but any such liability shall be limited to the extent that such loss was reasonably foreseeable at the time the contract was entered into. For the avoidance of doubt this clause in no way excludes or limits the liability for personal injury or death caused as result of the negligence of Growing The Game Ltd, its employees and affiliated bodies.

6. Growing The Game Ltd reserves the right to reject any applicant whom it considers to be anunsuitable person for involvement on its tennis training courses. This right may also be exercised retrospectively if information is brought to the attention ofGrowing The Game Ltd, which, if known at the time of the application, would have rendered the learner unsuitable. For the avoidance of doubt, the falsification of any information requested in this application form and/or the existence of any police record or caution relating to matters considered to be incompatible with certification, constitute circumstances where Growing The Game Ltd reserves the right to withdraw or suspend a learner’squalification.

7. Growing The Game Ltdreserves the right to cancel the course if enrolment numbers are fewer than 8. This is, however, an infrequent situation. In such cases, I will be offered the choice of a full refund or a place on another Growing The Game LtdLevel 2course. I understand alternative course venues and dates may not be as suitable to me as the one which I originally intended to attend.

8. Ihave stated in this application form that I amasking a third party to pay all or part of my course feeon my behalf. I understand that I must provide permission in writing from the organisation agreeing to pay my fees, obtaininga purchase order numberif necessary, and that these must be submitted with this course application. Failure to do so will result in my application being rejected. I also understand that I am responsible for ensuring that the third party pays my course fee by the start of the course, and that if the required fee has not been paid by the start of the course, I may forfeit my place on the course.

9. In the event of not being successful in my initial assessment on Day 5 of the course, I will beoffered the opportunity to be reassessed by Growing The Game Ltd. My reassessment will be held on a different course at a different date and venue, which must be agreed with the coach education manager at Growing The Game Ltd. I understand that there will be a non-refundable fee of £40 per reassessment.

DATA PROTECTION

Growing The Game Ltdwill 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 contact Nick Elliott at on 07774 940474

To help us develop coaches:

• Growing The Game Ltdwill also add your name and contact details to its secure database and you will receive occasional coach education newsletters and other relevant promotional material unless you tick this box: 
• Growing The Game Ltdmay contact you or send you information about other courses and products and about offers from carefully selected third parties by post, e-mail or SMS. By returning this form we will assume you have consented to this, unless you tick this box: 
• Growing The Game Ltdmay pass your contact details to carefully selected third parties so that they can send you, by post, details of their products and services. By returning this form we will assume you have consented to this, unless you tick this box: 

By signing this application, you are deemed to understand and accept the foregoing. I confirm that this application has been completed honestly and accurately:

Signature of applicantDate