Exit this survey Paratriathlon Talent Day - 7 Feb 2014 Question Title * 1. Full Name Question Title * 2. Gender? Male Female Question Title * 3. What age are you on the 31st of Dec 2016? 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Other Question Title * 4. Date of Birth (format DD/MM/YYYY eg 01/02/1991) Question Title * 5. Parent/Guardian's Name (If U18) Question Title * 6. Main Phone Number (If U18 parent/guardian) Question Title * 7. Alternative phone number (If U18 parent/guardian) Question Title * 8. Contact Email Address (If U18 parent/guardian) Question Title * 9. County Antrim Armagh Carlow Cavan Clare Cork Derry Donegal Down Dublin Fermanagh Galway Kerry Kildare Kilkenny Laois Leitrim Limerick Longford Louth Mayo Meath Monaghan Offaly Roscommon Sligo Tipperary Tyrone Waterford Westmeath Wexford Wicklow Other Other (please specify) Question Title * 10. Describe your disability Question Title * 11. Have you been classified in another Paralympic Sport? Yes No If Yes, please provide details Question Title * 12. Have you completed a triathlon? Yes No If Yes, please provide details Question Title * 13. What other sports have you competed in since your injury or impairment? Question Title * 14. Name your current coach (if any) Question Title * 15. How much time are you dedicating to training per week for triathlon? Question Title * 16. What are your short term Paratriathlon goals? Question Title * 17. What are your long term paratriathlon goals? Question Title * 18. Do you have your own Paratriathlon equipment? (wetsuit, bike/hand cycle, race chair etc?) Question Title * 19. Are you currently competing competitively in any other Paralympic Sport? Yes No If Yes, please provide details Question Title * 20. Why do you want to race in Paratriathlons? Thank you for your interest in the Paratriathlon Talent Programme.For further information on paratriathlon contact, jessica@triathlonireland.com Done