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British Judo Level 1 in Coaching
BJA Level 1 in Coaching Courses
Name
*
Mr
Mrs
Miss
Ms
Dr
Prof.
Rev.
Prefix
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Middle
Last
Gender
*
Male
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Date of Birth
*
DD slash MM slash YYYY
Are you a registered BJA member?
*
Yes
No
Please state which Association you are affiliated to
*
BJA Licence No:
Licence Expiry Date:
DD slash MM slash YYYY
Please upload a passport-style photograph:
Max. file size: 1 GB.
Address
*
Street Address
Address Line 2
City
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ZIP / Postal Code
Telephone
*
Email
*
Emergency Contact:
*
Ethnicity
*
I would my ethnic origin as;
Asian British Bangladeshi
Asian British Indian
Bangladeshi
Black African
Black British
Black Carribean
Chinese
Indian
Mixed White and Asian
Mixed White and Black African
Mixed White and Black Caribbean
Other
Other Asian
Other Black
Other Mixed
Other White
Pakistani
White British
White European
White Irish
White Non European
Prefer not to say
Disability
*
Do you consider yourself to have a disability?
Yes
No
If yes, what is the nature of your disability
Hearing
Learning
Physical
Visual
Mobility
Multiple
Other
Prefer not to say
How many years have you participated in Judo?
*
1
2
3
4
5
More than 5 years
What is your Judo grade?
*
3rd Kyu (Will be 2nd Kyu by course date)
2nd Kyu
1st Kyu
1st Dan
2nd Dan
3rd Dan
4th Dan
5th Dan
Do you have any competitive Judo experience, if so at what level?
None
Club
Regional
National
International
Roughly, how many years have you coached or assisted prior to this course?
*
Less than 1 year
1
2
3
4
5
More than 5 years
Please rate your coaching experience between 1-10 (Where 1 is limited and 10 is extensive)
*
1
2
3
4
5
6
8
9
10
How many times a week do you presently coach or assist?
*
1-3 sessions
3-5 sessions
More than 5 sessions
In the future, how many times a week would you like to coach?
*
1-3 sessions
3-5 sessions
More than 5 sessions
Please list any other relevant coach awards/certificates and/or qualifications you have gained:
If required, please upload relevant certificates
Drop files here or
Select files
Max. file size: 1 GB.
Have you any other information that you feel would be helpful for us to know prior to your attendance?
This information will remain confidential
Please select the course you would like to attend:
*
Please select your course
British Judo Level 1 Course - Core Judo Club - 17th - 18th December (£ 100.00)
British Judo Level 1 Course - Bungay (NAT12-21) 22nd-23rd Jan 2022 (£ 100.00)
Total
£ 0.00
Payment Details
*
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