<p> COURSE APPLICATION FORM CONFIDENTIAL If you need to contact us about your application: Telephone: 01975 641312 [email protected] www.fitnut.co.uk</p><p>About the Course you wish to apply for:</p><p>Course Name Level 3 Award in Instructing Boot Camp Fitness Training</p><p>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)</p><p>Please send a copy of your certificate with your application. Any application received without a copy certificate will not be processed.</p><p>Please tell us which prerequisite qualification you have attached with your application.</p><p>Dates of course (please check website for available course dates)</p><p>Where did you hear about the course?</p><p>About you:</p><p>First name Middle name</p><p>Last name</p><p>DOB (dd/mm/yyyy) Gender M F</p><p>Page 1 of 4 COURSE APPLICATION FORM CONFIDENTIAL</p><p>Please tell us how you would like your name to appear on your certificate</p><p>Your contact details:</p><p>Address</p><p>Postcode Home phone number</p><p>Mobile phone number</p><p>Your email address</p><p>Page 2 of 4 COURSE APPLICATION FORM CONFIDENTIAL</p><p>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).</p><p>Do you require any additional learner support? (please tick)</p><p>No Yes If yes, please indicate below what support would be required</p><p>Ethnic Origin (please tick)</p><p>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)</p><p>Page 3 of 4 COURSE APPLICATION FORM CONFIDENTIAL Data Protection</p><p>Fitnut Academy and YMCA adhere to their individual data protection policies; these are available upon request and also on the relevant webpages.</p><p>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.</p><p>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).</p><p>Contact name, Company Name and full postal address</p><p>Email address</p><p>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)</p><p>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.</p><p>SIGNATURE</p><p>NAME</p><p>DATE</p><p>Page 4 of 4</p>