Athlete Expression Of Interest - 2021 AusCycling Junior Track Nationals

Athlete Expression Of Interest - 2021 AusCycling Junior Track Nationals

Event Name: 2021 AusCycling Junior Track National Nationals

New Dates: Tuesday, 6 April – Sunday, 11 April 2021

Location: Anna Mears Velodrome, QLD

AusCycling Queensland (ACQ) proposes to select a QLD State Team of athletes to participate in the new AusCycling Junior Track Nationals in April. We are now calling for Expressions of Interest from AusCycling Queensland athletes.

To be considered for selection, Riders must:
Complete an Athlete Expression of Interest for the team.
Not be serving a racing license suspension of any kind.
Junior Track State Team Selection Policy
Abide by all Technical Regulations, By-Laws, and policies including Code of Conduct, Anti-Doping, Ergogenic Aids and Member Protection Policies of AusCycling.
Have a clear understanding of AusCycling Anti-Doping Policy, AusCycling National Member Protection Policy, AusCycling Child Safe Sport Code of Behaviour and AusCycling Code of Conduct
* Please note any athlete selected for a position within a QLD State Team will be required to complete and/or sign all of the following and submit/provide details to ACQ:
ASADA Anti-Doping E-Learning Course
Athlete Agreement - Available upon selection in to the 2021 Junior Queensland Team
CQ Financial Responsibility Agreement - Available upon selection in to the 2021 Junior Queensland Team

Please note: Submission of this form does not guarantee selection into the 2021 Queensland Junior Track State Team. ACQ will contact all athletes who have expressed interest regarding their selection/non-selection.

Athlete Expression of Interest for the 2021 QLD Junior Track State Team closes midnight Thursday, 10 December 2020.

Question Title

* 1. Please provide Athlete EOI Details:

First Name

Surname

Gender

Date of Birth

Age

Suburb/Post Code

Club Name

AusCycling Membership Number

Question Title

* 2. Please list the preferred contact details for all State Team communication:

First Name

Surname

Email Address

Mobile Number

Relationship to Athlete (Parent/Guardian/etc.)

Question Title

* 3. Please list any additional preferred contact person/details for all State Team communication:

First Name

Surname

Email Address

Mobile Number

Relationship to Athlete (Parent/Guardian/etc.)

Question Title

* 4. I can confirm that the Emergency Contact name and phone number listed on my membership is current?

Yes

Question Title

* 5. Please provide your medical details below:

Medicare Number

Medicare Expiry Date

Do you have Private Health Insurance (Yes/No)?

Private Health Insurance Provider

Private Health Insurance Member Number

Question Title

* 6. Please list any medical information/allergies/illnesses that you feel we should be made aware of:

Question Title

* 7. Please outline results/skills/experience/background that help support your Expression of Interest:

Question Title

* 8. Have you completed an ASADA Level 1 Certificate in 2020?
Please note: If you have already completed Level 1, you will need to complete the Level 2 ASADA Certificate.

Yes

Athlete Expression Of Interest - 2021 AusCycling Junior Track Nationals

Question Title

* 1. Please provide Athlete EOI Details:

Question Title

* 2. Please list the preferred contact details for all State Team communication:

Question Title

* 3. Please list any additional preferred contact person/details for all State Team communication:

Question Title

* 4. I can confirm that the Emergency Contact name and phone number listed on my membership is current?

Question Title

* 5. Please provide your medical details below:

Question Title

* 6. Please list any medical information/allergies/illnesses that you feel we should be made aware of:

Question Title

* 7. Please outline results/skills/experience/background that help support your Expression of Interest:

Question Title

* 8. Have you completed an ASADA Level 1 Certificate in 2020?Please note: If you have already completed Level 1, you will need to complete the Level 2 ASADA Certificate.

* 8. Have you completed an ASADA Level 1 Certificate in 2020?
Please note: If you have already completed Level 1, you will need to complete the Level 2 ASADA Certificate.