2023 State Team Registration - Athlete Non-Travelling Reserve

Medical
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone*
Medicare Number*
Medicare Expiry*
# on Medicare Card*
Private Health Fund Name
Private Health Fund Number
Doctor Name*
Doctor Phone Number*
Known Medical Conditions*
Please identify if there are any known medical conditions including those relating to asthma management, anaphylaxis, mental health, diabetes etc if there are no known medical conditions please put 'Nil'
Management Plan as applicable for any medical conditions

Cancelof
Food Allergies*
Please identify any food allergies, if there are no known allergies please put 'Nil'
Current Medications*
Please list any current medications, if there are no current medications please put 'Nil'
Please Note: Listed emergency contact will be contacted, if possible, prior to any medical attention being given. General medical aid, including transport, will be at the discretion of the Manager, or designated representative.
I hereby give permission for the Team Manager, or designated representative to seek medical aid in the event of an accident, injury or illness to the above team member.*

Yes
I give permission to seek medical aid for Traumatic injury requiring surgery.*

YesNo
I give permission for General Anesthesia if required:*

YesNo
I give permission for a Blood Transfusion if required*

YesNo
Blood Type (if known)

State Team Terms & Conditions
I hereby agree that the Gymnastic New South Wales Limited or any member thereof and/or any person and/or anybody or association associated in any way with the conduct or participation in this event (all of which persons, bodies or associations are severally and jointly included in the term "the indemnified") shall not be deemed responsible or liable in any way for any injury, illness or other mishap to me/us or my child (if under 18 years of age) sustained in, arising from or out of, or in any way directly or indirectly connected with any traveling, training, or function of whatever nature held during the period of the tour or prior or subsequent thereto if in any way connected directly or indirectly with the said tour and hereby indemnify the indemnified against any action, suits, courses of action, demand and claims by me/us or any other person or persons whatever made in connection with or arising out of such injuries, illness or mishap to me/us or my child and hereby agree (without in any way imposing or attaching any liability or obligation upon the indemnified to do so), that the indemnified may act as our agents in incurring such expenses as, and/or connected with or arising out of any such illness or mishap.

I (state team member) hereby to agree to become a member of the New South Wales Gymnastic Team to the AUSTRALIAN CHAMPIONSHIPS under the following conditions I undertake:

1. To travel to and depart from the place of assembly of the team upon the dates and means of conveyance decided by the NSWGA

2. Agree to pay all costs associated with the team tour and competition entry fees as outlined and understand that costs will be non-refundable if the State Team member withdraws for any reason.

3. To at all times during the tour act in accordance with the ‘Gymnast Code of Behaviour’.

4. To remain under the control, management and direction of the Manager or person appointed by him/her from the date of assembly until my return to NSW or official release from the team and to comply with all orders and instructions given by him/her or person appointed by him/her during that period.

5. To conduct myself in a proper manner and to exercise by best endeavors to render myself fit for competition and training during the tour and to return to NSW forthwith if ordered to do so by the Manager. I understand that my additional costs will be at my personal expense.

6. To disclose forthwith to the Manager any injury that might prejudice participation in the tour and understand that should I sustain an injury prior to the Australian Championships which leads to a withdrawal from the event, then I am not permitted to travel with the State Team.

7. On occasions prescribed by the Manager, to wear the official uniform.

8. To comply with all Gymnastics NSW policies and procedures including, but not limited to, the ‘Member Protection Policy’ and its codes of conduct, and the ‘Drug and Alcohol Management Policy’.

9. To comply with all other directions and instructions as provided by the team management and the NSWGA.

10. I agree that as part of the NSW state team, there may be still and / or video footage taken by Gymnastics NSW staff and associates. The association and/or their agents, reserve the right to use still images and / or video footage from the Australian Championships and related activities in any appropriate publications or promotions, including but not limited to; related websites, social media pages and media broadcasts. Any objection must be made in writing to Gymnastics NSW at the time of entry.
I understand and agree to the terms and conditions of membership on the State Team*

I agree
Team Management
Gymnastics NSW will manage team members only during training and competition times. All team members are expected to uphold the values and team expectations, including adherence to the Team Codes of Conduct for the entire duration of the team tour from point of departure, until return to Sydney at the conclusion of the tour, including when not under direct management of Gymnastics NSW Officials. Breaches of behaviour, value or conduct standards will be subject to disciplinary action, including but not limited to removal from the State Team, exclusion from competition and/or team activities and to be refused entry from future NSW events and tours, including, but not limited to competitions, events and the State Team. Gymnasts and Officials are to arrange their own travel to the competition and relevant training venues. There will be a designated meeting point at the competition venue for drop-off (sign-in) and collection (sign-out). More information will be released in future circulars.
I acknowledge the requirement to uphold the values and team expectations, including adherence to the Team Codes of Conduct for the entire duration of the team tour from point of departure, until return to Sydney at the conclusion of the tour, including when not under direct management of Gymnastics NSW Officials*

I agree
Breach of Discipline or Misbehavior
I acknowledge that in the event of any breach of discipline or misbehavior on my (the state team member) part, I am liable to the following penalties:

1. To be sent home with no refund of expenses.

2. To be excluded from competition or other activities as the Manager may see fit.

3. To be refused entry from future NSW events and tours, including, but not limited to competitions, events and the State Team.

4. To be disciplined under Gymnastics NSW policies relevant to the breach.
I agree to the above regarding breach of discipline or misbehavior*

I agree
Team Preparation, Education Sessions
As a member of the Gymnastics NSW team you will be required to take part in education sessions including Social Media and Sport Integrity requirements. Further information will be supplied in future circulars.
I agree to participate in required courses and education activities*

I agree
Gymnastics NSW Information Sheet and Waiver Intrastate and Interstate Travel
Information Sheet

This Gymnastics NSW Ltd (GNSW) Information Sheet and Waiver applies to athletes, coaches, team managers, officials and support staff (Participants) travelling intrastate or interstate for events administered, sponsored or authorised by GNSW, or events in which they are representing GNSW or a member club of GNSW (collectively, Events)

Risks to Participants

Participants acknowledge that in travelling to and attending an Event, a Participant may be exposed to a higher number of risks than they would ordinarily have in their home jurisdiction.

Participant may be exposed to the following non-exhaustive risks:
- suffering financial loss through the postponement or cancellation of an Event or withdrawal of their team or from their team;
- additional costs in changing travel at short notice, including but not limited to foregoing prepaid accommodation and changing flights;
- extended stay requirements due to illness and/or injury
- additional medical and associated costs
- potential loss of income related to the above risks
Waiver

On signing this Waiver, you (the Participant) acknowledge and declare, in connection with your travel to and from, and attendance at, the Event (Travel) that:
1. Engaging in Travel may expose you to certain risks (including but not limited to those outlined above). Prior to undertaking Travel, you should ensure you are aware of all risks involved. By signing this Waiver, you acknowledge and agree that you are undertaking any such risk voluntarily and at your own risk.
2. It is your choice to Travel and GNSW has not mandated you to Travel.
3. You will bear all costs incurred by you in connection with your Travel, including (but not limited to) any insurance costs, quarantine costs charged by the Australian Government or a State/Territory Government (or any other Government) and any other costs resulting from travel delays or restrictions. GNSW will not in any circumstances be responsible for such costs.
4. You will adhere to all public health directions or restrictions imposed by GNSW, the Australian Government or an applicable State/Territory Government (or any other Government) at all times during your Travel.
5. If you develop any cold and flu like symptoms (or other symptoms commonly associated with COVID-19) you will temporarily or permanently withdraw from the Event until such time as:
  1. you have returned a negative COVID-19 test; and
  2. it is otherwise safe for you to Travel and participate in the Event in accordance with the public health advice in place at the relevant time.
6. You, to the extent permitted by law:
  1. release and forever discharge GNSW from all actions, suits, proceedings, claims, demands, damages, penalties, costs or expenses (Claim) however arising from or in connection with your Travel or participation in the Event, including, without limitation, any Claim associated with the postponement or cancellation of the Event, or the withdrawal of your team from the Event;
  2. indemnify and will keep indemnified and hold harmless GNSW in respect of any Claim by any person:
    
    arising as a result of or in connection with your Travel; and
    
    against GNSW in respect of any death, injury, loss or damage arising out of or in connection with your failure to comply with any applicable public health directions or restrictions imposed by GNSW, the Australian Government or applicable State/Territory Government or other relevant health authority.
I confirm I have read and am aware of the "Gymnastics NSW Information Sheet and Waiver Intrastate and Interstate Travel" as detailed above.*

I agree
I understand that the tour is self funded and that the NSW State Team members (gymnasts, coaches and judges) will travel and accommodate independently for the Australian Championships. All travelling State Team members should refer to the Gymnastics Australia Travel Policy and Guidelines which can be found on the Gymnastics Australia website. Based on this all athletes on the State Team who are under 12 years must travel and stay with their parental guardians. Parents/guardians accompanying athletes under 12 years of age must not hold an official role on the state team whilst travelling. I understand that individuals are responsible for organising their own travel, accommodation, ground transport, travel insurance and meals for the tour*

I agree

Gymnastics Australia – Photography & videography release consent

Event/Activity: 2023 Australian Championships and 2023 Continental Championships

Location: Gold Coast, Queensland

Date: May 2023

Gymnastics is a highly visual sport, with images and vision of gymnasts competing and performing generating interest and awe the world over.
Gymnastics Australia takes its responsibility to ensure all members are safeguarded against potential risk in both the training and competitive environments seriously.

In May 2023, Gymnastics Australia will be holding the Australian Gymnastics Championships. To comply with all applicable policies, and ensure you understand the ways in which footage or images from this event may be used, the following information is provided for your consideration and consent.

It is important to note that you can change your mind at any time and ask us to stop using your image publicly by contacting us on media@gymnastics.org.au or integrity@gymnastics.org.au

Gymnastics Australia works collaboratively with the State and Territory Associations. Providing your consent through completion of this form, also expresses your consent to allow us to share your image or story, when appropriate, with our colleagues, unless you opt out below.

Throughout this Event, Gymnastics Australia will be capturing footage and images of each participant's routine in order to meet two priorities for the functioning of the event:

Priority 1: Judging Review Purposes – This is a mandatory requirement for all athletes wishing to participate at the event. Should an athlete not wish to comply with this requirement, their participation will be withdrawn by Gymnastics Australia prior to the commencement of the event. In this instance, no refunds on entry fees will be provided. Video footage captured for judging purposes will be;
- Used for judging a participant’s performance, should a score review be necessary
- Restricted to GA Event Staff, National Commission members and the event judges
- Retained at the completion of the event for a duration of 12 months after which it will be deleted. GA may, at its discretion, determine it necessary to retain footage after 12 months on a case-by-case basis.
Priority 2: All Other Purposes – Gymnastics Australia recognises not all individuals can or want to be captured for purposes other than their involvement in the competition, and provides mechanisms to support these requests. Footage or images captured for all other purposes may include, but is not limited to;
- Use for publicity, commercial or promotional purposes including advertising, social media, media and web content.
- Use for purposes within the GA accreditation and professional development domains. Footage or images can be accessed via user login by Gymnastics Australia staff and currently registered Technical Members from around Australia.
I grant Gymnastics Australia, its representatives and employees, the right to take photographs and film me, and/or a child in my care, in relation to the following in line with the Gymnastics Australia Photography Policy. I authorise Gymnastics Australia, its assigns and transfers to copyright, use and publish the same in print and/or electronically.*

I agree
Do you agree to footage or images being captured for Priority 1: Judging Review Purposes?*

Yes
Do you agree to footage or images being captured for Priority 2: All Other Purposes?*

YesNo for publicity, commercial or promotional purposes including advertising, social media and web content, educational or illustrative purposes.No for purposes within the GA accreditation and professional development domainsNo for sharing images with the State and Territory Associations
I authorise Gymnastics Australia, its assigns and transfers to copyright, use and publish the same in print and/or electronically.*

I agree

Optional Australian Championships Event T-Shirt

Gymnastics Australia is offering a 2023 Australian Gymnastics Championships event t-shirt. Athletes / Parents will place individual orders directly, orders will not be made through the State Association. Orders close by 4pm AEST Monday, 14th April. Due to the timing to Easter and the surrounding holidays, strictly no late orders will be accepted.

2023 AGC Athletes Tee – Gymnastics Australia Online Store

All orders are to be collected by the individuals directly from the Merchandise stand located in the competition venue.
I understand that individuals are responsible for placing the order for the Optional Australian Championships Event T-Shirt through Gymnastics Australia*

I agree
I confirm I have read and understand the information provided in "2023 GNSW State Team Circular 1 and 2"*

I agree
I confirm I have no outstanding financial obligations to GNSW*

I agree
I am not be subject to any disciplinary action or the investigation of a disciplinary action*

I agree
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 (under "Our Policies" at www.gymnsw.org.au). 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.*

I agree
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2023 State Team Registration - Athlete Non-Travelling Reserve

Medical

State Team Terms & Conditions

Team Management

Breach of Discipline or Misbehavior

Team Preparation, Education Sessions

Gymnastics NSW Information Sheet and Waiver Intrastate and Interstate Travel