candidate application form_g4r.docx

7/27/2019 Candidate Application Form_G4R.docx

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Course application form: HF 03/2011(03)

Candidate Application Form- Referee Course

If you are applying to attend a Volleyball England

Referee course, you should complete this form and returnalong with the fee of * (cheques made payable toVolleyball England)

The course organiser: Katharina Reuschor email [email protected]

*Grade 4= 35*Grade 4 BUCS= 20*Grade 4 Beach= 20*Grade C Sitting= 15

This information will be used by Volleyball England to register you. (* indicatesmandatory information).

Course details

Course Date(s)*:11th and 12th of May

9am - 5pm Fee Attached: 35Venue*: University Park Sports Centre, Nottingham, NG7 2RD

Essential Candidate Registration details*

First Name* Known as name:

Surname*Gender* (please circle) Male Female Date of Birth*:

Full postal address*:

Postcode*:

Contact telephone no*.:Public Email Address*:

Are you a student* Yes No Student Number*

Asian British Bangladeshi Indian Other White

Asian British Indian Mixed White and Asian Pakistani

Asian British Pakistani Mixed White and Black African Prefer not to say

Bangladeshi Mixed White and Black Caribbean White British

Black African Other White European

Black British Other Asian White Irish

Black Caribbean White Non-European Other Black

*Insert ph oto electroni cally, attach digit al ly to email or print & attach by pap er clip


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Chinese Other Mixed Background

Disability*

Do you consider yourself to have a disability?*(Please Tick) YES NO

If Yes, what is the nature of your disability? (Please Tick)

Hearing Multiple Mobility Other

Learning Visual Physical Prefer not to say

Declaration*

I am intending on refereeing players under the age of 18 (Please Tick) YES NO

I have a Criminal Records Bureau (CRB) check with Volleyball England:(Please tick if applicable)

If no, and a CRB check is required, Volleyball England will contact you YES NO

Data Protection: Any information provided by you will be held centrally by Volleyball England on itscomputer databases and by Volleyball England Commissions used for administering your involvementin Volleyball. Data may be passed to authorised data processes and used for this purpose.

If you do not wish any of your details to be disclosed to members or public enquirers please tick thisbox

We will from time to time contact you by telephone, email or other electronic means to promoteVolleyball England products and services. If you do not want to receive these communications pleasetick this box

This will mean you will NOT receive an electronic copy of 3Touch Volleyball magazine, the monthly e-newsletter or any other promotional communication from Volleyball England including information onevents and competitions.

We may from time to time pass your information on to carefully selected partners. If you do not wantyour details passed on to Volleyball England partners please tick this box

I agree to be bound by the Code of Conduct for Referees (available on the Volleyball England website)and accept the authority and jurisdiction of Volleyball England. I understand and agree to be bound bythe application, cancellation/refund and liability policy for Volleyball England courses.

By signing this form I agree to the terms and conditions in these documents.

Insert name: Date:


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candidate application form_g4r.docx

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