DCFA Private Providers Application Form

To apply for Derbyshire FA Private Provider Membership, please complete the below form:

 

Section 1: Organisational Details

 
 
 
 
 
 
 

This should be your total number of staff, including employed and self employed - full time and part time.

 
 

Section 2: Welfare Officer

 
 
 
 
 
 

Please provide the date completed this course

 
dd/mm/yyyy
 

Please provide the date completed this course

 
dd/mm/yyyy
 

Please provide the date completed the course

 
dd/mm/yyyy
 
 

Section 3: Policies

  1. Public Liability Insurance - up to the value of £10,000,000
  2. Organisational Structure - a copy of your organisational structure that displays shows clear reporting lines.
  3. Business Bank Account including Bank Name and Address.
  4. Safeguarding - copies of the following documents: Safeguarding Children & Vulnerable Adults Policy, Safeguarding Codes of Conducts and Safer Recruitment Policy
  5. List of all coaches (volunteers, part time and full time) including Full name and FAN.
  6. List of venues and session you deliver.
 
Drop your files here
 
 

Section 4: Declaration

By signing this declaration our organisation agrees to:


•    Commit to the requirements of Derbyshire FA’s Private Provider membership

•    Commit to ensure that all staff and coaches that are delivering sessions are listed with Derbyshire FA and adhere to all safeguarding requirements including having an in-date FA DBS

•    All information provided in this application is accurate to the best of our knowledge

•    Understand that if any of the required criteria is met or information is inaccurate then our Private Provider membership may be removed.

• Make a payment of £100 once the application has been approved

 
 
 
dd/mm/yyyy