Level 1 Coaching Course
All applicants must complete and return this form & bring the necessary documents to the course,
Please ensure you include information such as middle names, post codes, previous names etc.
Failure to give such information can delay your CRB check.
Title Mr, Mrs, Miss, Ms etc |
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Name of Applicant |
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Any Previous Names |
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If you have had previous names please give dates used from and up to. |
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Current Address |
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Telephone |
Home Mobile |
E-mail (please supply if you have one) |
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In order to improve contact between coaches and the FWA we ask that you enclose your e-mail address.
Please enclose payment of £160.00 per course attendee, this fee includes full costs for both the FWA Level-1 course and the Safeguarding & Protecting Children course. Please make cheques payable to The Federation of Welsh Anglers (FWA) unless to be paid by group organiser/a trust/angling club etc.
Your place is not secured until your payment has been received.
(PLEASE TICK METHOD OF PAYMENT)
Cheque |
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Postal Order |
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To be paid by group organiser/club |
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CONTACT DETAILS OF GROUP ORGANISER/CLUB etc (if applicable) to be invoiced NAME ________________________________________________________ ADDRESS _________________________________________________________ TEL NO: _________________________________________________________ EMAIL ADDRESS: |
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Additional Information
What is your preferred angling discipline? Coarse, Game or Sea……………………………..
There will be a written exam at the end of the Level-1 course, if for any reason you would prefer the exam to be given verbally by a tutor, with the tutor writing you answers on the exam sheet please tick this box.
Are you Welsh speaking?………………………………………………………………………………………………
Do you give your consent for us to publish your contact details on our website and other promotional materials as an active angling coach?……………………………………………………………………………
What is your preferred contact telephone number?………………………………………………………
What is the name of the Club you belong to and the area it is in?……………………………….
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The course fee includes an embroidered coach shirt.
What is your shirt size? XXL XL L M
Support is available to help with costs of attending this course. Grants through your club or organisation can be obtained through your Local Authority Community Chest Grant Scheme. Your club or organisation can also obtain funding for fishing tackle and equipment, health and safety equipment, first aid kits as well as other coaching related courses such as First Aid, Sport Development and Child Protection. In the first instance contact your local Council for more information and if you have any other queries then please contact our National Angling Coaching Co-ordinator:-
Helen Pearce
9 Maes Afallen
Bow Street
Aberystwyth
Ceredigion
SY24 5BL
Tel. 01970 820063
Email: helenpearce@toucansurf.com
We have 3 Regional Co-ordinators, details as follows:-
Southwest Region
Dave Gough, 226 Mynydd Garnllwyd Road, Morriston, Swansea, SA6 7QQ
Tel. 07799753058
Bdac.sec@ntlworld.com
North Region
Nick Massey, 17 Gilbert Street, Holyhead, Anglesey, LL65 2NR
Tel. 07748701326
Email: zandorion@aol.com
East Region
Andy Rawlings, 96 Maple Road South, Sebastopol, Pontypool, Torfaen, NP4 5AR
Tel. 07854008941
Email: cwmbran.aa@talktalk.net
Please send your completed application form to the relevant Regional Co-ordinator
CRB Check Details
All applicants must complete the following & bring it along to the Course
1. Do you hold a CRB certificate Yes / No (delete as appropriate)
(If yes please complete)
Date of issue |
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Disclosure number |
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Please provide copy of your CRB disclosure certificate
If you do not have a CRB disclosure certificate please complete the following
2.
How long have you lived at the above address: years months
- If less than 5 years please give previous address including post code
Please give dates when you lived at this address and dates when you left.
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4.
Date of Birth |
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. You must include your National Insurance Number otherwise your application can not be completed.
National Insurance Number |
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Please provide details of place of birth
Town / City |
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County / District |
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Nationality |
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If you were not born in the UK please state country of birth
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Please provide contact telephone number
Home: Mobile: |
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Please provide one of the following proofs of identity on the day of the course . Please note we need to see the original document. These will be returned to you on the day of the course. If you do not have one of these types of identify proof we will need to see a birth or marriage certificate.
Passport Number |
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Verification by Course organiser |
Nationality |
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Signature of Organiser______________________ Name of Organiser ______________________ |
Date of Issue |
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Date of Expiry |
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Driving Licence Number |
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Signature of Organiser ______________________
Name of Organiser _______________________ |
Licence Type |
Paper / Photocard (please delete that does not apply) |
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Country of Issue |
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Valid From |
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Expiry Date |
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9.
Please provide at least 3 different recent utility bills, gas, electric, telephone, mobile, or letter from local authority eg Council Tax Bill.
Please note that photocopies are not acceptable. These will be returned to you on the day of the course if provided.
Description of Document |
Signature of Course Organiser |
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Please provide at least 3 different recent utility bills, gas, electric, telephone, mobile, or letter from local authority eg Council Tax Bill.
Please note that photocopies are not acceptable. These will be returned to you on the day of the course if provided.
Description of Document |
Signature of Course Organiser |
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10.
Please give details of membership to any angling governing body, club, association etc. |
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11.
Please tick the licence category you are applying for;
Level 1 Angling coach |
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Level 1 Coaching assistant |
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Please state the preferred date that you would like to attend a level 1 course.
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