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2022 DIOCESAN SECONDARY SWIMMING ADDITIONAL EVENTS TO NSW CCC CHAMPIONSHIPS
Students who finished 2nd (or 3rd in the 50m Freestyle) at the Diocesan carnival on Thursday 10 March 2022 may apply for consideration for the NSW CCC Championship on Wednesday 6 April 2022 at Homebush, by completing the form details below.
The player profile section of this form will be used mainly to enable convener and selectors to place each participant so that they can best showcase their skills.
Please complete all questions (type N/A where not applicable)
Please complete by Tuesday 15 March 2022. Late applications will not be considered.
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* Indicates required question
Email
*
Your email
Swimmer's First Name
*
Your answer
Swimmer's Surname
*
Your answer
Gender
*
Male
Female
Date of Birth
*
Date of birth expressed as dd/mm/yyyy (please ensure you do not enter 2022 as the year of birth)
MM
/
DD
/
YYYY
Age in 2022
*
Your answer
Division
*
Junior (ages 12 - 14)
Intermediate (ages 15 - 16)
Senior (ages 17 - 18 +)
Required
School
*
Schools are arranged in alphabetical order according to town.
Choose
Ballina, Xavier Catholic College
Banora Point, St Joseph's College
Casino, St Mary's Catholic College
Coffs Harbour, St John Paul College
Grafton, McAuley Catholic College
Kempsey, St Paul's College
Lismore, Trinity Catholic College
Murwillumbah, Mount St Patrick College
Port Macquarie, MacKillop College
Port Macquarie, Newman Senior Technical College
Port Macquarie, St Joseph's Regional College
Woodlawn, St John's College
Medicare Number
*
Your answer
Private Health Fund Name
*
Your answer
Private Health Fund Number
*
Your answer
Medical Information
*
Please note here 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 Surname
*
Your answer
Parent First Name
*
Your answer
Parent Home Phone
Your answer
Parent Mobile
*
Your answer
Parent Email
*
Your answer
Trial Availability
*
Please click Yes to indicate if your child is available for CCC Championship at Homebush on Wednesday 6 April 2022. If the answer is "No" please do not complete this application.
Yes
No
Event Number 1
List the event number. Event numbers are listed on the Lismore Sport Website under Secondary > Swimming. See "Full Results" document. THESE RESULTS WILL NOT BE UPLOADED UNTIL AFTER THE DIOCESAN CARNIVAL
Your answer
Event Time 1
List the time
Your answer
Event Number 2
List the event number. Event numbers are listed on the Lismore Sport Website under Secondary > Swimming. See "Full Results" document. THESE RESULTS WILL NOT BE UPLOADED UNTIL AFTER THE DIOCESAN CARNIVAL
Your answer
Event Time 2
List the time
Your answer
Event Number 3
List the event number. Event numbers are listed on the Lismore Sport Website under Secondary > Swimming. See "Full Results" document. THESE RESULTS WILL NOT BE UPLOADED UNTIL AFTER THE DIOCESAN CARNIVAL
Your answer
Event Time 3
List the time.
Your answer
Event Number 4
List the event number. Event numbers are listed on the Lismore Sport Website under Secondary > Swimming. See "Full Results" document. THESE RESULTS WILL NOT BE UPLOADED UNTIL AFTER THE DIOCESAN CARNIVAL
Your answer
Event Time 4
List the time.
Your answer
Event Number 5
List the event number. Event numbers are listed on the Lismore Sport Website under Secondary > Swimming. See "Full Results" document. THESE RESULTS WILL NOT BE UPLOADED UNTIL AFTER THE DIOCESAN CARNIVAL
Your answer
Event Time 5
List the time.
Your answer
Concussion
*
Has your child had a concussion injury in the last 3 weeks?
No
Yes
Codes of Conduct
*
Click Yes if player and parents 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 behavioural 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.
Yes
No
Consent
*
I hereby consent to my son/daughter participating in the CCC Swimming Championship. 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.
Yes
Send me a copy of my responses.
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