ACCREDITED ATHLETICS COACH

REGISTRATION – 2016

Personal Trainer registering for

Level 2 Intermediate Recreational Running Course

Please fill in all forms, sign in all required places, attach your personal trainer certificate/s, scan and email to

Date & Location of Level 2 IRR course you are registering for:
Title
Surname
First name
Initial
Gender
Address
Suburb
State
Postcode
Country
Date of Birth
Phone Home
Please provide at least one phone no
Phone Work
Phone mobile
Email Address
Email format / HTML or PLAIN TEXT circle preferred option
Occupation
Are you involved with an Athletics Club / Yes or No
If YES, which club
List the events you coach
Are you a Aboriginal or Torres Strait Islander / Yes or No

First Year Registration is $55 (subsequent years $88)

Payment Method

(Please tick preferred option)


Cheque made payable to:
Athletics Australia
Athletics House
Level 2, 31 Aughtie Drive
Albert Park 3206

Credit Card (Please circle) Visa / Mastercard
Name:

Signature:
Card No:
Exp Date:

Member Protection Declaration

Athletics Australia has a duty of care to its members and to the general public who interact with itscoaches. As part of this duty of care and as a requirement of Athletics Australia, Accredited Athletics Coaches need to agree to the following Member Protection Declaration:
I sincerely declare:
1. I do not have any criminal charge pending before the courts;
2. I do not have any criminal convictions or findings of guilt for offences involving sexual activity, acts of indecency, child abuse or child pornography;
3. I have not had any disciplinary proceedings brought against me by an employer, sporting organisation or similar body involving child abuse, sexual misconduct or harassment, acts of violence, intimidation or other forms of harassment;
4. I have never been sanctioned for an anti-doping rule violation under any anti-doping policy applicable to me;
5. I will not participate in, facilitate or encourage any practice prohibited by the World Anti-Doping Agency Code or any other anti-doping policy applicable to me;
6. To my knowledge there is no other matter that The Company (Athletics Australia), itsassociations or clubmay consider to constitute a risk to its members, employees, volunteers, athletes or reputation by engaging me as an Accredited Athletics Coach;
7. I will notify the CEOof the organisation(s) engaging me immediately upon becoming aware that any of the matters set out in clauses 1 to 6 above has changed for whatever reason; and/or
8. Agree to provide a Police Check if requested by the governing body

ACKNOWLEDGEMENT
I have read the terms of the MPD and declare they are correct in every particular

Sign:

Date:

Child Protection

Children have a fundamental right to be safe from any form of abuse while involved in sport or associated activities. This is a legal requirement as well as a moral obligation. Child protection requires a commitment from all levels in sport to ensure sporting environments are safe for all children. This includes an awareness of the requirements and risks, a commitment to practices that minimise the risks, and the ability to appropriately respond to incidents of child abuse.
Visit the Australian Sports Commission website
Accredited Athletics Coaches are advised to consult further with the specific requirements for Working With Children that are of relevance to the state in which they are coaching, for a continuous period of more than 2 weeks.
Play by the Rules is a partnership between the Australian Sports Commission and all State/Territory sport and recreation and anti-discrimination agencies and provides advice on dealing with discrimination, harassment and child abuse for the sport and recreation industry.
The information on Play by the Rules is not intended to be, nor should it be relied upon as, a substitute for legal or other professional advice. Play by the Rules is supported by the Australian and State and Territory Governments.

ACKNOWLEDGEMENT
I have read the information relating to Child Protection and acknowledge that I will abide by the Child Protection requirements for Athletics Coaches as they relate in my state of residence.

Sign:

Date:

Member statement

I hereby make application for registration as an Accredited Athletics Coach with AthleticsAustralia.

I agree to abide by all the Rules and By-Laws of Athletics Australia and those of the its Member Association in the state where I reside, including Memorandums, Articles and By-Laws, general and specific codes of conduct contained therein and the Constitution and Rules of the International Association of Athletics Federation as amended from time to time.

ACKNOWLEDGEMENT
I have read the Member Statement and agree to abide by it.

Sign:

Date:

CODE OF ETHICS

I agree to:

  • Operate within the rules and spirit of your sport, promoting fair play over winning at any cost.
  • Encourage and support opportunities for people to learn appropriate behaviours and skills.
  • Support opportunities for participation in all aspects of the sport.
  • Treat each person as an individual.
  • Display control and courtesy to all involved with the sport.
  • Respect the rights and worth of every person regardless of their gender, ability, cultural background or religion.
  • Respect the decisions of officials, coaches and administrators in the conduct of the sport.
  • Wherever practical, avoid unaccompanied and unobserved one-on-one activity (when in a supervisory capacity or where a power imbalance will exist) with people under the age of 18 years.
  • Adopt appropriate and responsible behaviour in all interactions.
  • Adopt responsible behaviour in relation to alcohol and other drugs.
  • Act with integrity and objectivity, and accept responsibility for your decisions and actions.
  • Ensure your decisions and actions contribute to a safe environment.
  • Ensure your decisions and actions contribute to a harassment free environment.
  • Do not tolerate harmful or abusive behaviours.
  • Place the safety and welfare of the athletes above all else.
  • Help each person (athlete, official etc) reach their potential - respect the talent, developmental stage and goals of each person and compliment and encourage with positive and supportive feedback.
  • Any physical contact with a person should be appropriate to the situation and necessary for the person’s skill development.
  • Be honest and do not allow your qualifications to be misrepresented.

ACKNOWLEDGEMENT
I have read the Code of Ethics and agree to abide by it.

Sign:

Date:

Please complete the details above

RETURN including the payment of the $55 Registration fee to:

Coach Accreditation Coordinator

Athletics Australia

Athletics House

Level 2, 31 Aughtie Drive

Albert Park 3206

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