Competitors Expression of Interest Form for Talented Athlete Program

Competitors Expression of Interest Form
for
Talented Athlete Program – 2015/2016
Personal Details
Name:
Address:
Suburb:
Postcode:
Home phone number:
Mobile phone number:
Email:
Gender:
□ Female
□ Male
Surf Club:
Age Category:
□ U12
Preferred Discipline:
□ Swim
□ U13
□ U14
□ Board
□ U15
□ Ski
Season Results
Branch Championships
Event:
Place:
NSW Surf Life Saving Championships
Event:
Place:
Australian Surf Life Saving Championships
Event:
Place:
Additional Information / Results
□ U17
□ U19
□ Ironperson
□ Open
□ Beach
Competitors agree to
Selectors would like competitors, including Seniors, to:
Have a strong commitment to Surf Sports
Ability to attend all scheduled events and training days:
- Attend Training Day Sunday August 16 at Redhead from 10am to 2pm
- Skills Camp at Fingal Beach SLSC on Saturday 12 and Sunday 13 September 2015
- Attend Training Day Saturday October 17 at Birubi Point from 10am to 2pm
Be aware of the Competitors Code of Conduct
Ability/potential to compete and represent at Branch level
Competitors Signature: ____________________________________
Parent/Guardian signature if under 18: _____________________
Date: ____________________________________________________
Club Endorsement
Name:
Signature:
Position:
Date:
Branch Endorsement
Name:
Signature:
Position:
Date:
Return Form to:
Roslyn McMahon
Hunter Surf Life Saving
P: 02 4961 4533
F: 02 4961 4436
E: rozmcmahon@hsls.org.au
M: HSLS PO Box 44, Carrington NSW 2294
Closing date: 28th May 2015
N. B. :
This is an Expression of Interest form and does not guarantee Inter Branch Team
selection.