Instructor Qualifications
Name
*
First Name
Last Name
Email
*
example@example.com
Main dojo
*
Please Select
Bendigo
Berwick
Bon Beach
Caulfield
Christmas Hills
Clifton Hill
Glen Waverley
Heidelberg
Monash
Mornington
St Albans
Warrandyte
AKA membership number
*
Working with Children card number
*
Working with Children card expiry date
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Please upload your Working with Children card
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you have a National Police Check?
*
Yes
No
National Police Check expiry/release date
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Please upload your National Police Check
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please verify that you are human
*
Submit
Should be Empty: