Coach Registration

Coach Details

Name*

First Last

Email*

Enter Email Confirm Email

Mobile Number*

Home Phone

Address*

Unit/House Number Street Name Suburb Post Code

Enter the name of the team(s) you are coaching (if known)

Working with Children Check

Working with Children Check (WWCC) Registration Number*

It is Basketball Victoria’s policy that every coach has a Working With Children Check. Please provide your number above. If you haven’t yet applied for one please apply and enter your registration number above instead.
Use this link to apply for your WWCC if you do not yet have one
(a separate tab will open in your browser to allow you to do this whilst completing this form).

Have you added Caulfield Malvern Basketball Club to your WWCC registration?*

Yes

The Caulfield Malvern Basketball Club must be included as an organisation on your WWCC registration. To do this go to the Service Victoria web page (using the link below) and add an organisation to your registration with the following details:
Club Name: Caulfield Malvern Basketball Club
Address: PO Box 146 Central Park Vic 3145
Phone: 0418 733 655
You can use this link to go to Service Victoria to update your WWCC details
(a separate tab will open in your browser to allow you to do this whilst completing this form).

Coaching Experience

At what level have you coached before? (mark all that apply)*

No prior experience
Piranhas Domestic Level
Other Club Domestic Level
Representative Level
School/Education Level
Other

Please give details*

Please mark your coaching qualifications (if any)

Level 0 (Introductory)
Level 1 (Club level)
Level 2 (Association level)

Have you obtained any certifications relevant to the coaching role? (mark all that apply)

First Aid Management & CPR
CPR
Analphlayxis and Asthma
Other

Please give details*

Policies

Policies and Codes of Conduct*

Accept

Have you read and do you agree to comply with the club's policies and codes of conduct? Click here to view Club Policies and Codes of Conduct

Comments

Please add any further comments/requests regarding your coaching role

Name

This field is for validation purposes and should be left unchanged.