Coach Registration/Renewal Form

Fill in your details below to register as an RDA coach or renew your membership. You will be charged a fee of $20.00AUD.

You can also download the printable form here and post your form with payment to RDA Australia – PO Box 310, Torrensville, SA, 5031.

Your details

Title:

First Name

Last Name

Address line 1

Address line 2

Suburb/City

Postcode

State

Country

Confirm Email

Phone Number

Date of birth:

Do you identify as having a disability?

Yes
No

Your Current Coaching Qualifications

Level(s) of qualification:

+ Add another qualification

Senior Aid Certificate Date:

Approx. coaching hours per year:

RDA Centre(s) coaching took place:

+ Add another RDA Centre

Workshops attended in 2017

+ Add another workshop

Other RDAA Approved Activities (refer to the NCAS RDAA Updating Policy)

+ Add another RDAA approved activity

Other information

I have met my compulsory coaching activity for 2017 and wish to be re-registered as an RDAA Coach for 2018

I have read and understood the Coaches Code of Ethics and agree to abide by them

I am cleared for working with children and vulnerable adults and hold a current Senior First Aid Certificate (if applicable)

I declare that the information in this form is true and accurate and I understand that by not meeting these obligations I may be in breach of the Coaches Code of Ethics which may result in disciplinary action and may render my RDA coaching insurance invalid.

I wish to take leave from coaching in 2018 and will not be able to meet the minimum coaching requirements. I understand that if I do not complete the compulsory activities within two years that I need to update my coaching qualification as per the NCAS Updating Policy.

I wish to cease coaching with RDA until further notice.

You must tick the "Code of Ethics", "Cleared for Children" and the "This Information is true" check boxes

Payment: I have completed an Electronic Transfer Direct Deposit for my Coach Registration (do not tick this option if you wish to pay by credit card below)

Payment Details

Card Type

Card Number

Name on Card

Expiry Date

Card Security Code

How we secure your information

Submit registration