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HDSS Student Information Sheet

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10 views1 page

HDSS Student Information Sheet

Uploaded by

khangduong.emailvn
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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HDSS- Convenors Handbook

Updated 20/11/19
HINTERLAND DISTRICT SCHOOL SPORT
STUDENT INFORMATION SHEET
This sheet details your involvement in the sport in which you have chosen to nominate. It allows the convenor for your sport to have some
knowledge of your previous experience in the sport and your intentions regarding higher level competition. Please ensure that any relevant
information is included to assist the convenor.

Student Surname: _______________________________ Student Given Name: ___________________________ Gender:

Age: _________ Date of Birth: _________________


U School Attending: ________________________________________________

Sport: ______ Position(s) played (if applicable) _____________________________________

Student Email: ____________________________________________________________________________________________

School Representation: Indicate teams played for and any special recognition/ comments. Please list year achieved.

Club Representation: Indicate teams played for and any special recognition/ comments. Please list year achieved

Higher Level Representation (District/Region/State/National): Indicate teams played for and any special recognition/ comments.
Please list year achieved

Medical Information:
Parent/Guardian Name: Name: ______________________________ Mobile: _____________________________

Parent/ Guardian Email: ________________________________________________________________________________

Preferred hospital in the event of an emergency: ____________________________________________________________

Detail any medical condition that is relevant to his/her participation in this sporting activity: Particular note should be made of students on medication,
susceptibility to Asthma, allergies or any injury or condition that is likely to be aggravated by competition or by medical attention given the student. For example,
Diabetes, Heart conditions etc.
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Mouthguard Consent
The Department of Education Curriculum Activity Risk Assessment (CARA) guidelines mandate that mouthguards are compulsory for students wishing to participate
in a school sport representative event for these sports: AFL, Rugby League, Rugby Union, Hockey and Water Polo.
As the Parent/ Guardian, by signing this document, you are indicating that you understand that mouth protection is mandatory for the above listed sports and
that you accept responsibility for the type of mouth protection your child will wear whilst playing in these sports. If your son/daughter is unable to wear a
mouthguard for medical reason, then a signed medical clearance certificate is required prior to participation in the representative event.
▪ Please tick one of the boxes below (note this section is compulsory only if your son/daughter is trialing for AFL, Rugby League, Rugby Union, Hockey or Water Polo).
I confirm that my son/daughter:
□ has NO identified medical condition/s that may impact on their safety by wearing a mouthguard during participation in this sport.
OR
□ has an identified medical condition/s that may impact on their safety during participation in this sport and therefore cannot wear a mouthguard. The required
medical clearance certificate is attached.

Availability for Higher Level Competition and Liability for any Levies
If selected in the Hinterland District team, my son/daughter will be available to train with the Hinterland team, play at South Coast Regional trials and in the South
Coast Regional team at State level, if selected. I understand that the dates of these events are available from the Director of Sport at my school. I also acknowledge
the liability to pay any levies associated with Hinterland District Trials and/or Regional Trials.

Signed: __________________________ _______________________ ________


Parent/Guardian Director of Sport Date
Please note that Hinterland District events are not covered by member school guidelines. The decision to permit a student to attend trials, and any subsequent event
for which the student qualifies, is a parent/legal guardian responsibility. Hinterland District School Sport member schools accept no responsibility for provision of
transport to and from trials and events.

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