ACTIVE SURREY - Leatherhead Hockey Club：主动萨里-笨蛋曲棍球俱乐部.doc

ACTIVE SURREY CLUB AUDIT1.Club General Details:Official Club NameSport TypeFull Club AddressPostcodeTelephone NumberTraining/Match Address (if different from above)PostcodeTelephone NumberClub Website AddressClub Email Address2.Club Profile:2.1) What age ranges does your club cater for? (tick the boxes that are relevant)7yrs old and below8 10 yrs old11 13 yrs old14 15 yrs old16 17 yrsAdultsVeterans2.2) Does the club provide sporting opportunities for males and females? YES / NOProvide details (e.g. who you provide opportunities for, and what these are):2.3) How many junior participants do you have at the club? (Junior is U18s)Male Participants:Female Participants:2.4) How many adult participants do you have at the club? Male Participants:Female Participants:2.5) How many coaches and team managers does the club have?2.6) How many other active volunteers assist at the club? (e.g. chairman, treasurer etc. Any person who commits time to performing duties at the club in an unpaid role) 2.7) Does your club provide any sporting provision for disability sport? YES / NOProvide details (e.g. who you provide opportunities for, and what these are):2.8) Does your club own its premises? YES / NO2.9) Is your club registered as a Community Amateur Sports Club (CASC)? YES / NO2.10) Is your club a multi-sports club? (a club that has three or more sports on the same site) YES / NOIf yes, what other sports are located at your club?2.11) Is your club affiliated to its National sports Governing Body? YES / NO3.Club Development History:3.1) Does your club have contact with its National Governing Body development officer? YES / NO3.2) Does your club have contact with your local authority sports development officer? YES / NO3.3) Has your club applied for or received any funding in the past 10 years? YES / NOIf Yes, provide details regarding this funding project:3.4) Does your club have any sporting links into the local community? (e.g. links with schools, youth organisations, other community associations) YES / NOIf Yes, provide details about these links:Page 7 of 74.Club Coach & Volunteer Profiles:4.1)Club Coaches:Coach NameCoaching QualificationExpiry DateFirst Aid QualificationExpiry DateAttended Child Protection Course (Y/N)Criminal Records Bureau Check (Y/N)Team(s) coached at Club4.2) Key Club ContactsClubmark Lead for ClubAddressPostcodeTelephone NumberMobile Phone NumberEmail AddressIs this person Active Surreys main point of contact for Clubmark issues? YES / NOIf No, please attach relevant person(s) details at bottom of audit.Child Protection OfficerAddressPostcodeTelephone NumberMobile Phone NumberEmail AddressVolunteer Co-ordinatorAddressPostcodeTelephone NumberMobile Phone NumberEmail AddressChairman / PresidentAddressPostcodeTelephone NumberMobile Phone NumberEmail AddressTreasurerAddressPostcodeTelephone NumberMobile Phone NumberEmail AddressClub SecretaryAddressPostcodeTelephone NumberMobile Phone NumberEmail AddressJunior ContactAddressPostcodeTelephone NumberMobile Phone NumberEmail AddressAny Extra Information:Thank you for taking the time to complete this audit of your club. This information will greatly assist Active Surrey in determining suitable scheme