Personal Details (Please write clearly)

Name:

DOB:

Male / Female (please circle)

Address:

Parents Email:Student Email:

Mobile Telephone (parents):Home Telephone:

Former Primary School & Current School:

School year (as of September 2016):

Medical Conditions:

Polo Shirt Size: Small Medium Large

Leadership and Volunteering Aspirations

Please indicate what type of volunteering you would be most interested in getting involved in:

Coaching/ assisting a coachOfficiating

Mediae.gphotography, reporting, filmingTeam Management

Organising a competition/ event or festival

What sort of volunteer placement are you looking for?

A placement working in my school –lunchtimes and after school

A placement in a local sports club, community club or youth club

I already volunteer at a club and would like to continue there (Please name your club)

Qualification andTraining Interests

Please indicate what further training/leadership awards you would be interested in undertaking (you may tick more than one but should be prepared to attend the training)

Hockey Leaders AwardDisability / Inclusive Sports Training

Into Officiating Netball Award Intro to Gymnastics Judging Award

Junior Football Leaders AwardRounders Leaders Award

Multi Skill Leaders AwardAthletics Leaders Award

Tennis Leaders Award Other training/ awards – please specify below

Other……………………………………………………………………………………………………………………………………………………………….

Sporting Interests

What sports do you play at the moment?

What, if any, community clubs do you belong to?

Are there any sports/activities that you are particularly interested in getting involved in?

Data Protection Act 1998

The information on this form will be held by Hunts School Sports Partnership and shared with its partners. It will be used by Hunts School Sport Partnership and its partners to inform you of training, coaching updates and information and to keep them updated of any hours registered on line. It will also be used for research purposes and for sporting key performance indicators.

I confirm that the information on this form is correct to the best of my knowledge. I give my consent for Hunts School Sports Partnership to use my information and photographs for publicity purposes.

Ido / do not give permission for my son/daughter to have their photograph taken and the photos used to promote the work of the Hunts School Sports Partnership

(Please delete)

Signed………………………………………………………………………

Parent / Guardian Signature ……………………………………………

Date………………………………………………………………………

Please return to Miss Housden, along with a cheque for £25 made payable to ‘Hinchingbrooke School’

to secure your first year of Leadership Academy membership