2025 Wollondilly Performance Extension Program

Program nominating for at The South West Sydney Academy of Sport

Wollondilly Performance Extension Program
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Athlete Information

Please have the athlete fill in this next section under the supervision of a Parent / Guardian.

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For the purposes of sport selection, this is recognised as the gender assigned at birth.

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Please leave blank if you play an individual sport

Please leave blank if you play an individual sport

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Phone

Current address that the ATHLETE resides in

Current suburb that the ATHLETE resides in

Current postcode that the ATHLETE resides in

Current council area that the ATHLETE resides in

Wollondilly
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Current school that the ATHLETE attends

Current school year that the ATHLETE is in

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If you do not have a rep history, please leave blank

This can be what you have placed, personal bests, challenges etc...

Tell us why you want to be a part of The South West Sydney Academy of Sport' Wollondilly Performance Extension Program

Parent / Guardian - Contact Information

Please have a Parent or Guardian complete this next section.

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Phone

Parent / Guardian - Medical Information

Please have a Parent or Guardian complete this next section on behalf of the athlete.

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If no, please leave blank

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Athlete and Parent / Guardian Consent

The South West Sydney Academy of Sport will collect and store the information you voluntarily provide to enable processing of nominations for the program.


The information will be provided to relevant staff and to medical professionals where necessary in order to conduct the trial, or make a determination on the squad selection.


The "Name" and "Sport" of participants will be used in any relevant announcements and provided to council.


By providing South West Sydney Academy of Sport with the information you consent to these disclosures.


Any information provided by you will be stored on a database that will only be used for the purpose for which it was collected.


Any information provided by you to the South West Sydney Academy of Sport can be accessed by you during standard office hours and updated by writing to us or contacting us on 4627 7622.

I agree for my child/ward to attend the program and to undertake all activities and/or to participate in the Academy program.


I understand that although South West Sydney Academy of Sport and it's service providers attempt to minimise any risk of personal injury within practical boundaries, accidents do happen and all physical activities carry the risk of personal injury.


I acknowledge that there is an inherent risk of personal injury in physical activities that will be undertaken at the trials as part of the program and I accept that risk.


In the case of an emergency, I authorise the South West Sydney Academy of Sport, where it is impracticable to communicate with me, to arrange for my child/ward to receive such medical or surgical treatment as may be deemed necessary.


I also undertake to pay or reimburse costs which may be incurred for medical attention, ambulance transport and medication while my child/ward is attending the Program.

Declaration

I am nominating for a position within the South West Sydney Academy of Sport Wollondilly P.E.P program. I have read, understood and accepted the relevant eligibility criteria, privacy statements, risk warnings and I certify that all information supplied is true and correct.




I am aware of and agree to meet my obligations and expectations.

I give permission for my child/ward to apply for a position within a South West Sydney Academy of Sport Wollondilly Performance Extension Program.


I have read, understood and accepted the relevant eligibility criteria, privacy statements, risk warnings and I certify that all information supplied is true and correct, and understand that any attempt to falsify information in order to gain a position will result in the removal of the athlete from the program, and may be reported to the athletes State Sporting Organisation.


I am aware of and agree to meet the obligations and expectations that are required by my Child