Community Coach Course – April/May 2015

Application Form

Please read the Community Coach Course Information Sheet first. Email this completed form to by Saturday 28th February 2015.

Contact details

Name / Age
Address / Contact phone (home)
Email (please write clearly) / Cell phone

Please tell us about your background i.e. work history, previous experience

Do you have any previous experience in the fitness industry, group exercise and/or class instruction? If so please give a brief description.

How do you plan to use your training on completion of the course?

What support would you find helpful on completion of the course? i.e. help to find a mentor, help with setting up a class etc.

Do you have any special dietary requirements we need to be aware of? (Morning and afternoon tea refreshments will be provided)

Please confirm you have checked the course dates and times, and can commit to attending all the sessions. This is important for meeting course requirements.

¨  Yes, I can attend all the session times outlined below

Course dates and times

Saturday 18th April, 9.00am-4.00pm (Theory and Practical)

Sunday 19th April, 9.00am-4.00pm (Theory and Practical)

Saturday 2nd May, 11.30am-4.30pm (Group Fitness Day includes some mentoring)

Saturday 9th May, 9.00am-3.00pm (Mentoring and Assessment)

Using and managing your information

We need your permission to collect and use the information on this form. Please read the following statements and tick the boxes if you agree.

¨  "In submitting this form I agree to my details being used for the purposes of administering the Community Coach Course April/May 2015. The information will only be accessed by staff involved in planning and coordinating the course”.

¨  “I understand my data will be held securely and will not be distributed to third parties. I have a right to change or access my information. I understand that when this information is no longer required for this purpose, Active Canterbury will appropriately dispose of my data."

Thank you for your application. An email confirmation will sent on receipt of this application. You will be contacted by Friday 14th March to confirm your place on the course.