KEEN London - Coach Registration Form

Please enter your name...
Forename:
Surname:
...and some details about yourself:
Sex: Male
Female
Date of Birth:
Employment status: Full time education
Full time employment
Part time employment
Unemployed
Retired
If you're in full time education...
University or college:
Subject / course:
If you're in employment...
Employer:
Job title:
Now we need some contact details:
Address:
Town / City:
County / State:
Country:
Postcode:
Email address:
Phone number:
At the sessions
So that our volunteers and children can get the most out of the sessions, it's helpful to know a little bit about you—in particular, please give details of:
  • Any experience you have of working with children, or working with people with special needs
  • Any relevant qualifications you have (e.g. teaching, first aid)
  • Any particular interests you have that you'd like to use in our sessions (e.g. music/singing, any sports you particularly like, art/craft interests, storytelling—anything you like really!)
Any relevant experience, qualifications and interests:
Any medical conditions, disabilities or special needs of which we should be aware (e.g. bad back):
Which session are you most interested in attending?: North London (Tufnell Park) - Sundays
East London (Hackney) - Saturdays
South London (Vauxhall) - Saturdays
How did you hear about KEEN?:
DBS

Because of the sensitive nature of volunteering with KEEN, you are required to disclose details of any criminal record. Only relevant convictions and other information will be taken into account so Disclosure need not necessarily be a bar to working with us.

Note that this volunteering position is excepted under the Rehabilitation of Offenders Act 1974, which means that all convictions, cautions, reprimands and final warnings on your criminal record need be disclosed.

This means you must include all convictions you've ever had—even if they are now spent, or if you were a juvenile at the time.

A DBS check is a Disclosure and Barring Service check. If you don't have a DBS (or even don't know what one is), you can still volunteer with KEEN London - we will sort that out. But if you have a suitable one already, that will save us some time. (What is suitable?)
Do you have a suitable DBS? Yes
No
Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police? Yes
No
If so, please give details of offences, penalties and dates:
Are you aware of any police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post? : Yes
No
If so, please give details:
Referee details
Please provide the name and address of an independent person who we can contact for a personal reference. If possible, this should be someone who has knowledge of your previous work with children / special needs. (However, previous experience is NOT necessary to volunteer for KEEN London and training will be provided). Your referee should NOT be a friend or family member.
Referee's name:
Referee's email address:
Referee's phone number:
Referee's relationship to you:
Notes
Any notes you wish to include with your application:
Declaration
I understand that I will be coaching and taking part in sporting and recreational activities, I release and discharge KEEN London and its agents from any and all liability or responsibility for any accident or injury to person or property which may occur during the course of such activities, except for any liability or responsibility resulting from the gross negligence or wilful misconduct of KEEN London or any of its agents. I understand that photographic and video material may be taken and give my consent for it to be used in promotional materials.
Type your name to indicate agreement: