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

Question Title

* 1. Full Name

Question Title

* 2. Sport Nominating For

Question Title

* 3. Gender

Question Title

* 4. Date of Birth

Date

Question Title

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

Question Title

* 6. Parent/ Guardian Contact Email Address

Question Title

* 7. Parent/ Guardian Contact Mobile Number

Question Title

* 8. Parent/ Guardian (s) Name

Question Title

* 9. Home Address (please include suburb)

Question Title

* 10. School

Question Title

* 11. Current Club/Association

Question Title

* 12. Name of Coach

Question Title

* 13. Highest Level of Competition/Representation & Result

Question Title

* 14. How Long Have You Played/Competed?

Question Title

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

Question Title

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

Question Title

* 17. Passport Number

Question Title

* 18. Passport Expiry Date

Question Title

* 19. Medicare Number

Question Title

* 20. Do You Have Any Injuries?

Question Title

* 21. Permission To Call Ambulance?

Question Title

* 22. Emergency Contact Name & Number

Question Title

* 23. Do You Suffer From Any Known Allergies?

Question Title

* 24. Do You Have Any Dietary Requirements?

Question Title

* 25. Date of Last Tetanus Shot 

Question Title

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

Question Title

* 27. Fund Name & Member Number

Question Title

* 28. Do You Take Any Medications?

Question Title

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

Question Title

* 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

Question Title

* 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

0 of 31 answered
 

T