2024 NSW HPC Athlete Registration Form

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Please select who is completing this form* This field is required.

Parent/Guardian

Athlete (over 18 only)

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(Main Contact) Parent/Guardian 1

First Name

Last Name

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(Main Contact) Parent/Guardian 1 - Date of Birth

Date

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(Main Contact) Parent/Guardian 1 - Mobile

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Phone Number

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(Main Contact) Parent/Guardian 1 - Email

example@example.com

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Parent/Guardian 2

First Name

Last Name

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Parent/Guardian 2 - Mobile

04

Phone Number

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Parent/Guardian 2 - Email

example@example.com

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Family Address

Street Address

Street Address Line 2

Suburb

State / Province

Postal / Zip Code

Country

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(Athlete) Name

First Name

Last Name

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(Athlete) Date Of Birth

Date

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(Athlete) AddressOnly if different from the family address

Street Address

Street Address Line 2

Suburb

State / Province

Postal / Zip Code

Country

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(Athlete) Mobile NumberIf Applicable

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Phone Number

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(Athlete) E-mail

example@example.com

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Registered Gymnastics Club (Home Program)

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(Athlete) Education/Work StatusPlease select the option that is most applicable

Student (School)

Student (University or Similar)

Employed (Casual, PT or FT)

Other

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School, University or Employer's Name

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School/University Year for 2024 (If Applicable)Please enter the year as a number only. Example: Year 6 = 6 or 3rd year at university = 3

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School/University Contact Name (If Applicable)

First Name

Last Name

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School/University Contact Telephone (If Applicable)

Area Code

Phone Number

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School/University Contact Email (If Applicable)

example@example.com

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(Athlete) Medicare Number Please include the patient number (please put this at the end of the number. ie: XXXXXXXXXXX 4)

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(Athlete) Private Health Insurance

Private Health Insurer (ie: Bupa)

Card Number

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If yes, please specify details below

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General Anaesthesia * This field is required.

YESNO

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Surgery required for traumatic injury?* This field is required.

YESNO

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Blood Transfusion * This field is required.

YESNO

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Relationship to Athlete

Parent/Guardian

Spouse/Partner

Relative

Family Friend

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(Emergency Contact) Name

First Name

Last Name

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(Emergency Contact) Email

example@example.com

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(Emergency Contact) Mobile

04

Phone Number

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Please indicate your childs swimming ability and/or indicate if you do not give consent for their participation.

Has never swam before

Is learning to swim

Able to swim but needs guidance

Is a confident swimmer

I DO NOT consent to my child participating in aquatic activities

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NSW Aquatic AcknowledgmentBy ticking this box, you acknowledge and give permission for your child to participate in aquatic activities that is supervised and conducted by the Gymnastics NSW Men’s High Performance Centre. Consent to Medical Attention: In case of an emergency, I authorize the coach/staff member supervising, when it is impractical to communicate with me directly, to arrange for my child to receive such medical attention as may be deemed necessary. I am also aware that this may in some circumstances result is costs being incurred for such medical attention an am aware that this will be the responsibility of the family.

NSW HPC Aquatic Acknowledgement

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Squad

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NSW HPC FEE AGREEMENT:

By signing this fee agreement I agree and abide by the following terms and conditions:

· Payments are to be made monthly, via direct debit with Ezidebit. A direct debit form will be supplied.

· Ezidebit payments via Credit Card incur a 2.35% fee, payment via Bank account does not incur a fee.

· Failed payments will incur $21.90 fee

· In the event of a second or more ezidebit dishonor payment, Gymnastics NSW will add a $3.74 failed transaction fee and a $5 admin to the outstanding monthly invoice for each of the additional dishonored payments.

· If my child increases the amount of hours he trains, then a new fee will be charged commencing on the first day of the next calendar month.

· No rebates will be given for missed training sessions or sickness. (Extreme circumstances can be considered by applying to the High Performance Program Manager in writing.)

· All fees will need to be paid for in full by the start of the next calendar month. If fees are not paid then training will be suspended until the account is settled.

· If the gymnast withdraws from the program or is asked to leave the program, the account must be settled to a NIL balance.

· If a gymnast withdraws from the program, notice in writing must be given ONE MONTH in advance. Fees will be charged up to the conclusion of the one month notice.

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NSW HPC Fee Agreement * This field is required.I understand and agree to the terms & conditions set out by Gymnastics NSW & The Gymnastics NSW Men's High Performance Centre. I agree that I will abide by the NSW HPC Fee Agreement and I agree that I will pay all squad fees on time and in full. I understand that failure to do so may result in dismissal from the program.

Clear

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NSW HPC MEDIA RELEASE

There may be still imagery and video taken of NSW High Performance Centre (NSW HPC) athletes, including your child through events, training and/or at GNSW events. The NSW HPC, GNSW association and/or their agents, reserve the right to use still images and / or video footage of NSW HPC athletes in any appropriate publications or promotions, including but not limited to; related websites, social media pages, media broadcasts and / or print publications, and for sale in DVD. Any objection must be made in writing to The NSW HPC and/or GNSW upon registering for the NSW HPC. Medical - give permission for the emergency treatment, if I or my nominated others cannot be contacted. I understand that all associated costs of this treatment are my liability and not that of the NSW High Performance Centre NSWHPC, Gymnastics NSW and / or its representatives. Note: Parents will be contacted, if possible, prior to any medical attention being given. I hereby indemnify the NSWGA and its affiliated clubs, their officers, coaches and assistants against any claim by or on behalf of the child/myself.

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NSW HPC Media Release Agreement* This field is required.Please acknowledge that you agree to the following

NSW HPC Media Release Agreement

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NSW HPC MEDICAL AGREEMENT:

I give permission for the emergency treatment as outlined under "Medical Approval", if I or my nominated others (emergency contact) cannot be contacted. I understand that all associated costs of this treatment are my liability and not that of the NSW High Performance Centre, Gymnastics NSW and / or its representatives. Note: Parents will be contacted, if possible, prior to any medical attention being given. I hereby indemnify the NSWGA and its affiliated clubs, their officers, coaches and assistants against any claim by or on behalf of the child/myself.

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NSW HPC Medical Agreement* This field is required.Please acknowledge that you agree to the following

NSW HPC Medical Agreement

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NSW HPC AGREEMENT:

I hereby accept a position within the NSW High Performance Centre (NSW HPC) and agree to all terms and policies set out by Gymnastics NSW and the NSW HPC. I acknowledge that I have read and agree to all rules and policies set out in the NSW HPC Squad Handbook and understand that these can be updated at any time. I acknowledge that failure to abide by all rules and policies may result in an athletes placement status being reviewed, or if deemned necessary dismissal from the program.

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NSW HPC Agreement* This field is required.Please acknowledge that you agree to the following

NSW HPC Agreement

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NSW HPC PRIVACY COLLECTION STATEMENT:

Gymnastics NSW Ltd (GNSW) is collecting your personal information (PI) to facilitate your application and administer your membership benefits. GNSW may use and disclose your PI as set out in this statement and our Privacy Policy (found on the GNSW Website]. If you do not provide your PI, we will not be able to administer your member benefits. We may disclose your PI to other parties, including our service providers, partners and sponsors (that may be located overseas from time to time). We may use and disclose your PI to provide you with publications, news, promotions and offers, and to contact you to help us improve our products and services, unless you opt out (see our Privacy Policy for details on opting out). Our Privacy Policy contains information about how you may access and seek correction of your PI, how to complain about a breach of your privacy, and how we will deal with that complaint.

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NSW Privacy Collection Statement* This field is required.Please acknowledge that you agree to the following

NSW Privacy Collection Statement