Transcript Document

Girls and Womens Youth Club Coach Workshop
Ravenscraig Regional Sports Facility - Friday 10th May 2013
Please complete the form fully in block capitals and return to (Insert address)
Title:
Mr
Mrs
Miss
Surname:
Ms
Gender:
Male
Female
Name:
E-mail:
(This is essential as all correspondence for this course is via email)
Home telephone:
Mobile telephone:
Full address:
Postcode:
Date of Birth:
Club:
Quality Mark Approved
tick if applicable
Please provide details of any medical conditions, disabilities, dietary requirements or specific needs:
Course Details
Date of Event/Course: Youth Club Coach Workshop
Venue: Ravenscraig Regional Sports Facility
Time: 5.30pm
Equity Monitoring
The Scottish FA is committed to promoting equality and eliminating discrimination. We seek this information for monitoring participation in football only
and will not use it for any commercial purpose or share it with any third party.
Please mark (X) in ONE box which best describes your ethnicity
□ White Scottish
□ Polish
□ Bangladeshi
□ African
□ Other British
□ Pakistani
□ Chinese
□ Caribbean
□ Irish
□ Indian
□ Arab
□ Mixed Race
□ If ‘other’ please specify:
□ Prefer not to say
Please mark (X) in ONE box which best describes your religious denomination
□ Christianity
□ Judaism
□ Hinduism
□ Islam
□ Buddhism
□ Sikhism
□ If ‘other’ please specify:
Do you consider yourself to have a disability?
□ None
□ Prefer not to say
□ Yes
□ No
□ Prefer not to say
Terms and Conditions
1.
2.
3.
4.
5.
6.
7.
Applications should be received prior to course commencement.
The Scottish FA reserve the right to cancel or amend the arrangements for any course.
The Scottish FA is strongly committed to equal opportunities for all participants. It is the policy of the Scottish FA to ensure that all course
participants receive equal treatment regardless of age, gender, marital status, employment status, social class, colour, race, ethnic or national
origin, religious belief or disability.
The course member agrees to abide by the rules laid down by the Scottish FA and its Staff.
Your information will be used by the Scottish FA to maintain and update course attendance records
If you do not wish to be included in future mailings please tick the relevant box: for coach education
for referee development
From time to time, photographs and video footage may be taken during events/courses for promotional purposes.
If you wish to opt out of this please tick the box.
The Scottish FA is always seeking to recruit volunteers into the game. If you are interested in receiving information regarding
volunteering opportunities please tick this box
I have read and agreed with the above terms and conditions
Signed:
Date: