COACHING REGISTRATION FORM

Please complete this form when any of the details listed below change

Coach Name Coach Name First Last
Date of Birth Date of Birth / DD / MM YYYY
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Phone
MWBA Registration/Insurance Number (if known)
Coaching Accreditation Level
Upload accreditation Certifcate

Attach Files
Working With Childrens Check (WWCC)

For Coaches over 18 years of age.
WWCC Number. Must be a current, with an Employee clearance level.
WWCC Expiry Date
In Case of Emergency:

In the case of a referee under who is under 18, we will contact the parent listed above first
Name Name First Last
Relationship
Phone
Terms and Agreement.
I understand if I do not hold a current MWBA Membership, the associtaion will register me and deduct payment from my pay.

MWBA Memberhsip will be at a coaching level and cost $15. This will cover you for injury when working on a MWBA approved program/camp and last for 12 months. This level of cover does not cover you for playing competition.

I understand if I do not hold a current MWBA Membership, the associtaion will register me and deduct payment from my pay.

MWBA Memberhsip will be at a coaching level and cost $15. This will cover you for injury when working on a MWBA approved program/camp and last for 12 months. This level of cover does not cover you for playing competition. I agree to have payment deducted I have my own Personal Injury Cover and will email the COC
Permission to Publish

Permission to Publish I do not give permission for my image to be used on the MWBA website, Facebook Page, Instagram Account, or in any advertising or promotional materials.
Disclaimer

Disclaimer By checking this box I acknowledge that as a member of Manly Warringah Basketball Association and a Coach registered with Basketball NSW, I agree to act in accordance with the constitutions, by-laws and Codes of Conduct of both Associations, and understand that any infraction of these Codes will be addressed under the BNSW Judiciary Tribunal or the MWBA Administrative Tribunal.
Name Name First Last
Date Date / DD / MM YYYY

COACHING REGISTRATION FORM

COACHING REGISTRATION FORM

Working With Childrens Check (WWCC)

In Case of Emergency:

Terms and Agreement.