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 $25.00AUD.

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

Do you identify as having a disability?

Yes
No

Senior First Aid Certificate Date:

I have a:

WWCC
National Police Check
DHS (previously DCSI) Check
Equivalent Clearance (please provide details)

Are you paid for coaching at RDA?

Yes
No

RDA Coaching Status:

Would you like information about taking out Public Indemnity Insurance with RDA Australia?

Yes
No

If this donation is for a specific purpose, please enter it here:

Your Current Coaching Qualifications

Level(s) of qualification:

+ Add another qualification

Approx. coaching hours per year:

RDA Centre(s) coaching took place:

+ Add another RDA Centre

Workshops attended in 2019

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

I am continuing as a Member of an affiliated RDA Centre in 2020 and have met my compulsory coaching activity for 2019 and wish to be re-registered as an RDAA Coach for 2020

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.

Authorised Reference:

Name:

Position:

Contact phone or email:

I wish to take leave from coaching in 2020 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, and complete the autorised reference information.

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)

Coach Registration/Renewal Form

Your details

Your Current Coaching Qualifications

Workshops attended in 2019

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

Other information

Payment Details

Coach Registration/Renewal Form

Your details

Your Current Coaching Qualifications

Workshops attended in 2019

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

Other information

Payment Details

Card Security Code

How we secure your information