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[]
[" ",null,null,null,"BC Amateur Athletics Association"]
[null,null,null,null,"#2001B - 3713 Kensington Ave., Burnaby BC  V5B 0A7"]
[null,null,null,null,"Phone: (604) 333-3556      Fax: (604) 333-3551"]
[null,null,null,null,"E-mail: sam.collier@bcathletics.org  Website: www.bcathletics.org"]
[]
["BC Athletics School Club Coach Membership"]
[]
["School Club Coach Memberships are complimentary when submitted with a School or School District Club application."]
[]
["Application date:        "]
[]
[]
[]
["School:"]
[]
["Name (Last, First):"]
[" ",null,null,null,null," ",null,null," "]
[]
["Birthdate:",null,null,null,null,null,"NCCP#"]
[null," "]
[]
["Phone:  ",null,null,"Most recent CRC Date:"]
[]
["Email:"]
[]
["Country of Birth:",null,null,null,null,"Citizenship:"]
[]
["Coaching Certification: Indicate your HIGHEST LEVEL of certification in Athletics:"]
[]
["Sport Coach:",null,null," ","Club Coach:",null," "," ","Other:"]
[" "]
["Event areas you are currently coaching:"]
[null," ",null,null," ",null," "," "]
[]
[null," ",null,null," ",null,null," "]
[]
[null," ",null,null," "]
[]
[]
["Number of athletes currently coaching:   "]
["Male:",null,null,"Female:",null,null,"Age Range:"]
[]
[" "]
["BC Amateur Athletics Association Sport Safety/Acknowledgment of Risk"]
["NOTE:  These statements are part of the application for membership."]
["The responsibility for sport safety must be shared by all.  I, the undersigned, am aware that there is a certain risk of  "]
["injury involved in my own or my child's participation in sport: either while travelling to or from the event; or while  "]
["attending or participating in the programs or activities of the events which are sanctioned/approved by BC Athletics,  "]
["its Divisions, its Member Clubs or recognized organizing societies.  It is understood by me that the signing of this  "]
["document is intended to indicate that on behalf of myself and/or my child I assume the shared responsibility and  "]
["acknowledge the risk of inury by so participating."]
["BC Athletics Privacy Policy"]
["By completing this membership application form, signing and joining BC Athletics you consent to the collection of  "]
["this information and its use as per the BC Athletics Privacy Statement and Policy - see Identifying Purposes -  "]
["Appendix II of the Policy available at www.bcathletics.org.  For more information or to limit the release of information"]
["contact the BC Athletics Privacy Officer, Sam Collier at sam.collier@bcathletics.org"]
[]
[null,null,null,null,null,null,null,null,null," "]