Munster Rugby Domestic Game Department
IRFU Stage 3 (Level 1) Coaching Course Application Form
Course Fee: €220
Name: ___________________________
Contact No: _______________________
Email: ___________________________________________
DOB: ____________________________
Club/School: _____________________________________
Course Venue:_________________________
Course Date:_____________________________________
Please state the team you will be coaching next season: ___________________________________
Coaching Position:_____________________________________________
(ie – Head Coach, Asst. Coach, Backs, Forwards etc)
Coaching Experience
Year
Team
Club Reference Name
Club / School
Coaching Position
Contact Number
Courses Attended
Year
Venue
Accredited
Stage 1 (Mini)
Stage 2 (Foundation)
Stage 3 (Level 1)
Other
I understand that part of the Stage 3 accreditation involves being observed by a Munster Rugby development officer and agree
to be observed during a training session. I declare all information given on this application is correct.
Tick to confirm
Applicant Signature: ____________________________
Date:___________________
To be completed by Club/School Officer
I approve the above nomination from our club/school
Signature:______________________________________________
Print Name (
Position in club / school :_____________________________
Club/School: ________________________________
)
Date:____________________
Disclaimer: Coaches are requested to fulfill a practical element on this course. Munster Rugby and the IRFU are
not liable for any injuries incurred. Coaches are required to attend an IRFU Safe Rugby Course as an accreditation
requirement. This is done at their own cost and is not included in the original course fee.
Form to be returned to: Janes Burns c/o Coaching and Development Office, Munster Rugby Domestic Game Department, Irish
Independent Park, Tramore Road, Cork. Enquiries: Tel: 021-4925818 or Email: [email protected]