Triathlon Athlete Nomination Form 2025/26
Athlete Information
Name
*
First Name
Last Name
Birthdate
*
/
Day
/
Month
Year
Date
Gender
*
Please Select
Male
Female
Non-Binary/Gender Fluid
Gender Identity not sufficiently represented
Are you of Aboriginal or Torres Strait Islander Descent
*
Please Select
Yes
No
Athlete Email
*
example@example.com
Athlete Mobile Number
Please enter a valid phone number.
Address
*
Street Address
Street Address 2
Town
State
Postcode
Council LGA
*
Please Select
Armidale Dumaresq
Glen Innes Severn
Gunnedah
Gwydir
Inverell
Liverpool Plains
Moree Plains
Narrabri
Tamworth Regional
Tenterfield
Uralla
Walcha
School
*
e.g. Tamworth Public or Oxley High
Shirt size
*
Please Select
Womens size 8
Womens size 10
Womens size 12
Womens size 14
Mens size S
Mens size M
Mens size L
Mens size XL
Mens size XXL
Parent/Guardian Contact Details
Parent Name
*
First Name
Last Name
Parent Phone Number
*
Please enter a valid phone number.
Parent Email
*
example@example.com
Second Parent Name
First Name
Last Name
Second Parent Phone Number
Please enter a valid phone number.
Second Parent Email
example@example.com
I give permission for my child to be photographed at NIAS activities for promotional purposes
*
I give permission
I do not give permission
Medical Details
Emergency Contact
*
First Name
Last Name
Emergency Contact Mobile Phone Number
*
Please enter a valid phone number.
Permission to call ambulance?
*
Please Select
Yes
No
Medicare No.
*
Private Health Fund Name (If applicable)
Fund Member Number
Do you have ambulance cover with private health?
Yes
No
Do you have any medical conditions?
*
If yes, please specify.
Do you have any ongoing/chronic injuries?
*
Sport Information
Current Club
*
Triathlon Coach Name
First Name
Last Name
Triathlon Coach Email
example@example.com
Triathlon Coach Mobile Number
Please enter a valid phone number.
If you do not have a triathlon coach please state why
Please indicate if you meet the auto selection criteria for RAS Programs
Podium result at the 2024/25 TNSW Super Sprint Race Weekend
Top 3 in the overall Youth Point Score in the NSW Billigence Pathway Series in 2024/25
Podium Result at 2025 Academy Games
Podium Result at Australian Super Sprint Championships
On average, how many hours do you swim per week?
*
Please Select
<2 hours
2.5 - 5 hours
5.5 - 8 hours
8.5 - 10 hours
>10 hours
On average, how many kilometers do you swim per week?
*
Please Select
<10 km
11-15km
16-20km
21-25km
>26km
What is your 400m swim time within the last 12 months and where/what event did you swim this?
*
On average, how many hours do you cycle per week?
*
Please Select
<50kms
51-100kms
101-150kms
151-200kms
201-250kms
On average how many hours do you run per week?
*
Please Select
<1 hour
1-2 hour
3-4 hours
4-5 hours
>5 hours
On average how many kilometers do you run per week?
*
Please Select
<10kms
11-20kms
21-30kms
31-40kms
4150kms
51-60kms
61-70kms
What is your 1500m run time within the last 12 months and where what event did you run this?
*
What were your top 3 triathlon performances in the 2024/25 season?
*
What do you want to get out of being part of the State Pathway Program?
*
Do you participate in other sports? If so, what sport and how many hours per week do you play/train?
*
Please upload a letter of recommendation from a current coach and/or PE teacher.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please verify that you are human
*
Submit
Should be Empty: