Fitnut Academy Course Application Form

COURSE APPLICATION FORM CONFIDENTIAL If you need to contact us about your application: Telephone: 01975 641312 [email protected] www.fitnut.co.uk

About the Course you wish to apply for:

Course Name Level 3 Award in Instructing Boot Camp Fitness Training

Entry Requirements Learners need to have achieved one of the following prerequisite qualifications in order to take part in this course:  Level 2 Certificate in Fitness Instructing (QCF) in any of the following disciplines: - Gym-based exercise - Exercise to music - Water-based exercise - Health related exercise and physical activity for children  Level 2 Certificate in Fitness Walking (QCF)  Level 2 Certificate in Instructing Circuit Training Sessions (QCF)  Level 2 Certificate in Instructing Parkour/Freerunning Fitness Training (QCF)

Please send a copy of your certificate with your application. Any application received without a copy certificate will not be processed.

Please tell us which prerequisite qualification you have attached with your application.

Dates of course (please check website for available course dates)

Where did you hear about the course?

About you:

First name Middle name

Last name

DOB (dd/mm/yyyy) Gender M F

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Please tell us how you would like your name to appear on your certificate

Your contact details:

Address

Postcode Home phone number

Mobile phone number

Your email address

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Relevant qualifications and/or membership of professional bodies you may have: Qualifications (continue on a separate sheet if necessary) Date obtained Awarding Body (e.g. exam Educational (e.g. GCSE passes); Vocational (e.g. NVQ awarded); board or professional body Occupational qualification and/or certification held and currently providing certification). valid (e.g. fork lift truck licence); Professional (e.g. member of the Institute of Personnel and Development).

Do you require any additional learner support? (please tick)

No Yes If yes, please indicate below what support would be required

Ethnic Origin (please tick)

White British Mixed White & Black African White Irish Chinese White Other Asian or Asian British Indian Mixed – White & Black Caribbean Asian or Asian British Pakistani Mixed - Other Asian or Asian British Bangladeshi Black or Black British African Asian or Asian British - Other Black or Black British Caribbean Mixed – White & Asian Black or Black British Other Prefer not to say Your own preferred definition (please indicate)

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Fitnut Academy and YMCA adhere to their individual data protection policies; these are available upon request and also on the relevant webpages.

All Course Fees must be paid in full prior to course commencing. Please tick one of the payment methods below: We will contact you within 48 hours of receiving your completed application form to arrange payment. Please send me a payment request via PayPal at total cost of £206.80. (No PayPal account required, you can checkout using a valid Credit or Debit Card.) A fee of 3.4% has been added to the total cost of the course to cover the payment processing fee.

Please send me an invoice at total cost of £200 with details of how to make payment through a direct bank transfer or Bacs payment. There is no processing fee for this method of payment. (If the Invoice has to be sent to a company, please provide full details below of who and where this has to be sent).

Contact name, Company Name and full postal address

Email address

Discounts – 10% Discount available for Students, Armed Forces and Charitable Organisations. I am a Student (Send a copy of your Student Card with the application form) I am with the Armed Forces (Send a copy of your ID Card with the application form) I work for a charitable organisation (Send a copy of your ID Badge or a covering letter from your organisation stating you are currently employed by them)

Declaration by applicant I confirm that to the best of my knowledge the information provided on this form is accurate and complete. I agree and understand that information will be processed in accordance with the Data Protection Act.

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