BRENT SPORTS DEVELOPMENT COACH PROFILE FORM
As a service we would like to gather detailed information on qualified coaches within Brent. The information on this form will be held on Brent Sports Service’s Database and will be used for monitoring purposes and to inform you of training, employment and personal development opportunities relating to coaching. We would also like to be able to provide organisations who are looking to work with coaches of your details, this would be via either the telephone, internet or a printed coach directory.
Please complete this form with as much detail as possible for our database. Information marked * will be available via the telephone, internet and coach directory if you wish. Please tick the relevant box next to each question with regards to which medium you agree to your information being shared.
Section 1—Personal Information (Please use capital letters) / Or tick AllI agree to have this information made
available to others by
Phone / Brent
website / Printed
Directory / Database
Only
* Title / [ ] / [ ] / [ ] / [ ]
* Surname / [ ] / [ ] / [ ] / [ ]
* First Names / [ ] / [ ] / [ ] / [ ]
*Permanent Address / [ ] / [ ] / [ ] / [ ]
Post Code
Telephone No
* (Day) / [ ] / [ ] / [ ] / [ ]
* (Evening) / [ ] / [ ] / [ ] / [ ]
* (Mobile) / [ ] / [ ] / [ ] / [ ]
Date of Birth
* E-mail / [ ] / [ ] / [ ] / [ ]
*Please list languages spoken / [ ] / [ ] / [ ] / [ ]
*Gender / Male [ ] / Female [ ] / [ ] / [ ] / [ ] / [ ]
*Do you have up to date insurance? / Yes [ ] / No [ ] / [ ] / [ ] / [ ] / [ ]
* Are you First Aid qualified? / Yes [ ] / No [ ] / [ ] / [ ] / [ ] / [ ]
*Do you have CRB clearance? / Yes [ ] / No [ ] / [ ] / [ ] / [ ] / [ ]
Would you be interested in having this, or renewing it if applicable? / Yes [ ] / No [ ]
Do you have a drivers licence? / Yes [ ] / No [ ]
Do you have access to a car? / Yes [ ] / No [ ]
Section 2— Coaching Information
* Please list below your sports coaching qualification (s) including courses/training, such as
Lifesaving etc.
Sport / Qualification/Course Title / Date Achieved / Expiry Date / Member of NGBE.g. Athletics / UKA Level 1 (Assistant Coach) / 28/07/04 / N/A / Yes
I agree to have this information made
available to others on
Phone / Brent
website / Printed
Directory / Database
Only
*Do you have experience of coaching
disabled people? / Yes [ ] / No [ ] / [ ] / [ ] / [ ] / [ ]
*How many years have you been involved in coaching? / 1 [ ] / 1 - 5 [ ] / 6+ [ ] / [ ] / [ ] / [ ] / [ ]
*When are you available to coach? / Day time / [ ] / [ ] / [ ] / [ ] / [ ]
Evening / [ ] / [ ] / [ ] / [ ] / [ ]
Weekends / [ ] / [ ] / [ ] / [ ] / [ ]
School Holidays / [ ] / [ ] / [ ] / [ ] / [ ]
Not
available / [ ] / [ ] / [ ] / [ ] / [ ]
Are you currently coaching? / Yes [ ] / No [ ]
If yes, which sport (s)?
Who for? Please state organisation name
Assisting a club [ ] / Working in schools [ ] / Working for a local authority [ ]
Please describe your coaching history
Employer/Club / From / To / Type of coaching (e.g., within a club, school) / Age group coached
E.g. Brent Tennis Club / 07/02 / 07/04 / Individual and group coaching within the club / 7 - 11 yr olds
Sport / Age / Level of participant / Gender
4 - 6 / 7 - 11 / 12 - 18 / 18 + / Beginner / Improver / Club / Male / Female / Mixed
I have attended / I would like to attend
First Aid training / [ ] / [ ]
Equity in your coaching / [ ] / [ ]
Good practice and child protection / [ ] / [ ]
Working with disabled sports people / [ ] / [ ]
Coaching children and young people / [ ] / [ ]
Working with children / [ ] / [ ]
Are there any other NGB qualifications/training courses you would be interested in attending
Name / Name
Address / Address
Postcode / Postcode
Telephone No / Telephone No
Position / Position
Thank you for taking the time to complete the form, please return to, Sports Development Team, Coach Database, London Borough of Brent, First Floor East, Brent House, 349—357 High Road, Wembley, HA9 6BZ or e-mail . If you have any queries please call 020 8937 3707, forms are available to download from our Website on