Coaching Registration form

Coach Bowls
Registration Form
Personal Details:
Full Name
Date of Birth
Address
Postcode
Telephone (Home)
Telephone (Work)
Telephone (Mobile)
Email Address
Qualification Details:
Codes Coaching In
Current Level Level 1 Level 2 Level 3 Advanced
Age Range Coached
Club
(Please include club postcode)
County
Date First Qualified
Coaching Role Status Volunteer Paid Part Time Paid Full Time
Generic Training:
CRB Registration Number
Equity Course Attended
Safeguarding & Protecting
Children Attended
Yes / No (Please delete) If yes, date of course:
Yes / No (Please delete) If yes, date of course:
First Aid Course Attended Yes / No (Please delete) If yes, title and date of course:
Please complete all sections in BLOCK
CAPITALS and tick boxes where applicable
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Helping people to live longer, healthier and more fulfilling lives
Bowls Development Alliance Ltd,
Registered in England and Wales no. 07205402
Registered Office: David Cornwell House, Bowling Green, Melton Mowbray, Leics, LE13 0FA
www.playbowls.org

Coach Bowls
Registration Form
Additional Skills:
Qualified Teacher Status
Qualified Tutor Status
Yes / No (Please delete) If yes, date qualified:
Yes / No (Please delete) If yes, date qualified:
Qualified Assessor Status Yes / No (Please delete) If yes, date qualified:
Qualified Verifier Status
Yes / No (Please delete) If yes, date qualified:
Mentor Training Completed Yes / No (Please delete) If yes, title and date completed:
Please complete all sections in BLOCK
CAPITALS and tick boxes where applicable
Equal Opportunities Monitoring - Optional:
Ethnic Background
Prefer not to say
A White B Mixed C Asian or Asian
Black
British
Irish
White & Black
Caribbean
White & Black
African
D Black or
Black British
Indian Caribbean Chinese
Pakistani Afican Other
Other White & Asian Bangladeshi Other
Other
Other
E Chinese or Other
Ethnic Groups
Disability
Do you consider yourself a disabled person? Yes No Prefer not to say
If you have indicated yes, please tick all the boxes that apply to you:
Visual impairment Mental health issues Physical impairment
Hearing impairment Learning disability/
difficulties
Religion
Prefer not to say
None Christian Jewish Sikh
Buddhist Hindu Muslim Other
Page 2 of 4
Helping people to live longer, healthier and more fulfilling lives
Bowls Development Alliance Ltd,
Registered in England and Wales no. 07205402
Registered Office: David Cornwell House, Bowling Green, Melton Mowbray, Leics, LE13 0FA
www.playbowls.org

Coach Bowls
Registration Form
Data Protection Statement:
The Bowls Development Alliance will be developing a Bowls Coach Finder on our website and will be updating it with
details of all registered coaches, registered with the BDA. Details that will be displayed on the system will be: your name,
contact email address, current coaching level and location of the club that you currently coach at.
If you do not want your details displaying on the Bowls Coach Finder please tick here
Please complete all sections in BLOCK
CAPITALS and tick boxes where applicable
We will not use your personal details to pass on to any other third party, other than in the case stated below.
The information that you provide on the Coach Registration Form is confidential except to the extent that we have to make disclosures to prevent
children from being placed at risk. Such disclosures could be to official agencies for example, the Police or Children’s Social Care which have a duty
to investigate allegations of child abuse and criminal activity, bowls clubs and other individuals and organisations sharing concerns regarding child
protection. Any disclosures will be in accordance with the Data Protection Act 1998.
Fees Payable 2012/13:
Please make all cheques payable to Bowls Development Alliance Limited
Coach Membership Fee 2012/13: £8.00
Declaration:
I declare that the above information is correct and I have read the Data Protection Statement.
Signature: ………………………………………………………………
Date: ……………………………………………..
Please return your completed form and payment to: BDA, PO Box 10191, Melton Mowbray, LE13 9EL
PLEASE ENSURE THAT YOU HAVE COMPLETED THE
NO CLAIMS DECLARATION FORM ON PAGE 4 AS THIS IS A REQUIREMENT
UNDER OUR INSURANCE POLICY
Page 3 of 4
Helping people to live longer, healthier and more fulfilling lives
Bowls Development Alliance Ltd,
Registered in England and Wales no. 07205402
Registered Office: David Cornwell House, Bowling Green, Melton Mowbray, Leics, LE13 0FA
www.playbowls.org

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