Instructor Registration and Induction Form

Annual Instructor Registration & Induction Form
Club Location*
Your Instructor's Name*
Your Name*

First NameLast Name
Your Profile Picture

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Your Date of Birth *

DayMonthYear
Date
Year Commenced Training*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Personal Email*
example@example.com
Personal Phone Number*

Area CodePhone Number
Name Emergency Contact *

First NameLast Name
Emergency Contact Number*

Area CodePhone Number
Have you every had your teaching title or rank cancelled or removed*

YesNo
Please Confirm The Below
Please confirm your role within club*

Assistant Brown/Black Belt Helper ( Volunteer / Help at Gradings/ in Class )Lead Instructor (under supervision)Senior Instructor (Run own club)School Self Defence InstructorMaster Coach (State Training Manager)
Options for teaching click here
Day(s)/Time(s) you teach class (or days/times available to teach or help with classes)*
Please Confirm*

Motor Vehicle and current drivers' licensePassword protected computer and smart phone access to reliable fast internet accessPrivate workspace to conduct confidential and undisturbed writing, calls and emails and a secure storage for hard copy filesSecure Lockable briefcase or Satchel to ensure document safety when travelling or offsite
Please Supply Below
Business Name Registration Certificate or (Trading as Name)

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ABN (Optional) (Required if using Club Manager )
GST Registered

YesNo
Current Drivers License *

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Current National Police Check (required once every 3 years / upload your previous one if up to date)

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To apply for National Police Checks click here https://www.afp.gov.au/what-we-do/services/criminal-records/national-police-checks
Current Working With Children Check (REQUIRED for all adults working with any child under 18 including on the grading day/advanced days)*

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To apply for Working With Children Check (VIC): https://www.workingwithchildren.vic.gov.au/individuals/applicants/how-to-apply
Prohibited Weapons License (Club Instructors Only if Teaching Prohibited Weapons)

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To apply for Prohibited Weapopns License click here https://www.police.vic.gov.au/forms-and-applications
Current First Aid Certificate*

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To apply for First Aid Training Courses click here https://www.stjohnvic.com.au/first-aid-training/first-aid-courses/
Current COVID -Safe Certificate - Martial Arts Instructor under (MAIA)

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To enrol into Covid Safe Certificate course click here https://covidsafemartialartsschool.com/courses/covid-safe-return-to-martial-arts/

Please Enter Current Ranks Below*

	Rank Achieved	System of Martial Arts	Date on Grade Certificate
1
2
3
4
5
6

Please Enter Current Teaching Titles Below (if applicable)

	System of Martial Arts	Teaching Title	Date on Teaching Title Certificate
1
2
3
4
5

Upload all Certificate for Current Ranks and Teaching Titles

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Permission and authority (Instructors only)Please confirm by ticking box if you have previous signed the below
Signed Copy Contractor Agreement (School Program Instructors)

YesNo (Please fill in the form next to step 2)
Signed Copy Licensing Agreement (Club Instructors / School Program Instructors)*

YesNo (Please fill in the form next to step 2)
Signed Copy Confidentiality Agreement (Office Staff, Club Instructors, School Program Instructors)*

YesNo (Please fill in the form next to step 2)
Signed Copy Statuatory Declaration (Club Instructors, School Program Instructors)*

YesNo (Please download and upload the form below)
Download - Statuatory Declaration
Upload - Statutory Declaration

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Upload - COVID-19 Vaccination Certificate

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I have read and understood and agree to the "Student Code of Conduct" and the "Black Belt Pledge".
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I have read and understood and agree with the "Student Code of Conduct " and the "Black Belt Pledge" responsibility to inform you of any changes therein, immediately.*

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Instructor Terms and Conditions
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Annual Instructor Registration & Induction Form