<p> YORKSHIRE NETBALL LEADERSHIP & COACHING WORKSHOP BOOKING FORM</p><p>When applying for a Yorkshire Netball course please complete ALL information on this booking form:</p><p>Workshop Name: First Step into Leading & Coaching Netball Cost: £20 Venue : Bradford College (Trinity Road Campus), Easby Road, Bradford, BD7 1JG Date: Wednesday, 1st July 2015 Time: 6.30p.m – 9.30p.m Candidate Name (Ms/Mr/Miss/Mrs):</p><p>Affiliation Number / Netball ID No: (if applicable) </p><p>Candidate Address:</p><p>Contact Telephone No: Home: Mobile: E-mail address:</p><p>Date of Birth: (Applicants must be 16 years of age) Emergency Contact Name:</p><p>Emergency Contact No:</p><p>Medical Information (e.g epilepsy, asthma, diabetes, allergies etc)</p><p>Please list below any Netball or any other sport related awards / qualifications you currently hold:</p><p>Awards Level Date achieved Please provide information on your reason for wanting to do this course, i.e. helping at child’s school or club, Back to Netball team support, etc</p><p>Please provide brief information on your current knowledge and/or involvement in netball, if any</p><p>Are you able to actively take part in the game of Netball?** Yes No </p><p>If no, please detail the reason: ………………………………………………………….…</p><p>……………………………………………………………………………………….….………</p><p>** Please note: For some practical workshops participants may need to be actively involved in netball skills and drills. If you are not able to actively take part, please inform the course organiser at the point of booking.</p><p>Payment:</p><p>By Cheque or BACS payment only Cheques must be made payable to ‘Yorkshire Netball’ with the candidates name clearly printed on the back and returned to:</p><p>Debbie Chandley, Netball office, E.I.S, Coleridge Road, Sheffield, S9 5DA</p><p>BACS payment details:</p><p>HSBC, 1 Well Croft, Shipley, West Yorkshire, BD18 3QH Sort Code: 40-41-44 Account No: 91733486</p><p>If paying by BACS please ensure you provide a reference detailing the reason for payment i.e First Steps Netball</p><p>Cancellation Policy: ‘Yorkshire Netball’ operate a ‘no refund’ policy. Requests to cancel a booking should be directed to Debbie Chandley and will be considered on an individual basis. For monitoring purposes, please can you complete the following additional information. Thank you.</p><p>Are you male or female? Date of Birth What is your ethnic group?</p><p>White White British Black or Black Black Caribbean  British African  Other Black </p><p>Mixed White & Black Caribbean  Chinese or Other Chinese  White & Black African  Ethnic Group Other Ethnic Group White & Asian </p><p>Other Mixed </p><p>Asian or Asian Indian  Prefer not to say  British Pakistani </p><p>Bangladeshi  Unknown  Other Asian </p><p>The Disability Discrimination Act 1995 defines a disabled person as anyone with a ‘physical or mental impairment which has a substantial and long-term adverse effect upon his/her ability to carry out normal day to day activities.’</p><p>Do you consider yourself to have a disability? If Yes, what is the nature of your disability? Visual  Learning  Hearing  Multiple  Physical  Other  Prefer not to say </p><p>Cheque received: Yes ⇩ No ⇩</p><p>Place confirmed Yes ⇩ No ⇩</p>