Please ensure you have read through all the information, including eligibility, on http://www.hunteracademy.org.au/icg-2020 before completing this form.

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* 1. Full Name

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* 2. Sport Nominating For

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* 3. Gender

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* 4. Date of Birth

Date / Time

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* 5. Have you Been a Member of Team Lake Mac Before?

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* 6. Parent/ Guardian Contact Email Address

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* 7. Parent/ Guardian Contact Mobile Number

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* 8. Parent/ Guardian (s) Name

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* 9. Home Address (please include suburb)

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* 10. School

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* 11. Current Club/Association

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* 12. Name of Coach

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* 13. Highest Level of Competition/Representation & Result

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* 14. How Long Have You Played/Competed?

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* 15. Preferred Events (Please list 2 for Athletics & 4 for Swimming with current personal best result)

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* 16. How Did You Hear About Team Lake Mac?

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* 17. Passport Number

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* 18. Passport Expiry Date

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* 19. Medicare Number

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* 20. Do You Have Any Injuries?

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* 21. Permission To Call Ambulance?

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* 22. Emergency Contact Name & Number

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* 23. Do You Suffer From Any Known Allergies?

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* 24. Do You Have Any Dietary Requirements?

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* 25. Date of Last Tetanus Shot 

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* 26. Are You A Member Of A Private Health Fund?

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* 27. Fund Name & Member Number

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* 28. Do You Take Any Medications?

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* 29. Athlete Declaration: I am applying for a position in Team Lake Macquarie, if selected, I agree to fulfill all obligations to the program

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* 30. Parent/Guardian Declaration: I have read and understand the information provided for this program and give my child permission to apply for a position in team Lake Macquarie

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* 31. Social Media Consent: I give consent to the Hunter Academy of Sport and Lake Macquarie Council to use my name, photograph and/or video online, whether it be on a website or on social media pages

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