Coach Education Course Booking Form Name of course you wish to book onto: Course Date:
Venue:
Name: Address: Postcode:
Mobile & home telephone:
Email address: Male/Female:
Date of Birth:
Do you consider yourself to have a disability?
YES
NO
If YES, please state:
Ethnic Origin (please circle): Asian
Asian British
Black
Black British
Chinese
Mixed
White
Other
Do you have any specific requirements? E.g. Access: Are you registered on RightCoach?
What is the main sport that you are involved in? Position/Role within that sport? E.g. Coach, volunteer When was the last time you coached/volunteered? Club/School/Organisation Name: If you are part of a club, are you accredited, e.g. ClubMark, Swim 21? How did you hear about the course? Please circle: WASP website
SCUK Website
WASP Coaching News
Your Organisation
Your National Governing Body
Your Local Authority
Other, please state:
Please send your completed form along with a cheque made payable to Wiltshire and Swindon Sport CIC to: Dominique Oughton, WASP, 48 New Park Street, Devizes, Wiltshire. SN10 1DS