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Nomination

  *-Required

Athlete Information

Have you been a member of a HAS squad before: Yes
No
*
Program to Nominate for: *
Given Name: *
Surname: *
Date of Birth (e.g 01/02/2001): *
Email Address: *
Gender: Female
Male
*
Aboriginal Torres Strait Islander: Yes
Non English Speaking Background: Yes
Height (cm) (e.g. 170): *
Weight (kg) (e.g.80): *
Street Name and Number: *
Suburb: *
State: *
Postcode: *
Mobile Phone (no spaces): *
School:

Parent/Guardian Contact Details

PLEASE NOTE: the majority of Academy correspondence will go to the 'Parent Email' please enter an email address you monitor frequently so you don't miss any notifications.
Fathers Name: *
Fathers Phone Number (no spaces): *
Mothers Name: *
Mothers Phone Number (no spaces): *
Parent Email: *
Council LGA: *

Medical Details

Medicare Number: *
Do you have any injuries: *
Permission to Call Ambulance: *
Emergency Contact: *
Emergency Mobile Number: *
Do you suffer from any known allergies?: *
Member of a Private health fund: Yes
Fund Name:
Fund Member Number:
Medications: *
Medical Operations/Conditions: *
Ambulance Cover with Private Health:

Sport Information

Golf H'Cap (if applicable):
GolfLink Number:
Netball Ump Badge & year acquired (if applicable):
Current Club/Association: *
Coach Name (netball umpires, please enter Assoc. umpire convenor name):
Level of Competition/Representation:
Result:
How long have you played/competed: *
Preferred Position/s: (Please list 2 in order of preference): *
How did you hear about the program?: *

Declaration

Athletes Declaration: Yes *
I am applying for a position into the Hunter Academy of Sport. If selected, I agree to fulfill all obligations to the Academy Program
Parent Declaration: Yes *
I have read and understand the information provided for this program and give my child/ward permission to apply for a position in the Hunter Academy of Sport Program
Selection Trial RSVP : Yes
No
*
If a selection trial has been set and you are unable to attend, please provide your reason for non-attendance below and send HAS relevant documentation (i.e. medical certficate for injury/illness).
If unable to attend the trial, please provide reason here:
Social Media Consent: Yes
No
*
I give consent to the Hunter Academy of Sport to use my name/child's name, photograph and video on the Hunter Academy of Sport website, promotional materials and media releases provided by the Hunter Academy of Sport

Usage of Players Names, Photographs and Video Clips

Due to the current legislation relating to Player Protection it has become necessary to seek Parental/Player permission for the usage of Player photographs and names on websites, print, verbal or visual media. The Hunter Academy of Sport likes to promote all of its sporting programs as well as recognise the achievements of participants of Academy events. We understand that people like to see their name and photo on websites, newspapers and television, but we are also aware of the implications that this can have on individuals and their families. As a result it is mandatory that the section above be completed. Any decision prohibiting the Player's name or image will be respected by the Hunter Academy of Sport under the Player's Protection and Privacy Laws.
Security :
*