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2017 CCC SECONDARY ATHLETICS CARNIVAL - 1500m WALK
CONSENT, MEDICAL, CONTACT & PLAYER PROFILE INFORMATION
This compulsory registration process is only for those players who would like to be considered entry for the 1500 metre Walk event at the CCC Athletics Championships to be held at Homebush on Friday 15 September 2017. Parent(s) / Guardian(s) must submit an official and verifiable hurdle time please.

Please complete the consent form by Wednesday 26 July 2017. Please complete all the questions (type N/A where not applicable).

Players First Name
Your answer
Players Surname
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
School
Medicare Number
Your answer
Health Fund Name
Your answer
Health Fund Number
Your answer
Medical Information
Please note any medical/health information of which managers should be made aware e.g. allergies, dietary restrictions, medication, puffer, epipen etc. Please type N/A if none.
Your answer
Parent First Name
Your answer
Parent Surname
Your answer
Parent Home Phone Number
Your answer
Parent Mobile Number
Your answer
Parent Email
Your answer
Event Nomination
Please select the event your child is nominating for
Best officially recorded time for distance nominated
If no time recorded for the distance selected, please submit official time for another Walk distance and specify that distance
Your answer
Date Time Recorded
List the date that the time you are submitting was recorded
MM
/
DD
/
YYYY
Web Address or other means for checking of your best time
Your answer
Parent Confirmation
Please click YES below to indicate that a parent (not student) has completed this form
Code of Conduct
Click Yes if player and parent/s have read and will abide by their respective codes of conduct at these trials and that you understand and accept that your child is to behave in an appropriate manner and have explained this obligation to him/her. Clicking Yes also indicates that you are aware that if your son/daughter seriously contravenes behavioral expectations, he/she may be immediately excluded from the trial. Should this eventuate, you accept full responsibility for your son/daughter upon notification of his/her exclusion by the convener. Yes also indicates that you are aware that the child's school may take disciplinary action after this event and that future Diocesan sports representation may be in jeopardy.
Consent
I hereby consent to my son/daughter participating in Diocesan Secondary 1500 metre Walk trials. I understand that transport to and from the venue and accommodation is a parent/guardian responsibility. In the event of accident or illness I authorise the obtaining on my behalf of any such medical assistance that may benefit my child. I accept responsibility and expenses incurred. Please note that your child's school and/or zone might also require written consent for this activity.
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