Contact details

Is this application for our PARA swim team?

Yes

No

What is your classification?

Impairment type?

Name

Date of birth

Mobile

Email

Facebook

Instagram

Residential address

Postal address

Family Emergency contact details

Mother's name

Mother's email

Mother's mobile

Father's name

Father's email

Father's mobile

Family home address

Medical information

Medical conditions

Regular medications

Allergies and reactions

Dietary requirements

Recent illness or injuries

Home club and coach

Club

Coach name

Coach mobile

Coach email

*Coach classification - optional *For PARA applicants ONLY

Service team

Physiotherapist

Strength and conditioning

Sport psychologist

Dietitian/nutritionist

Other - optional please specify

Main events - long course

Event

PB

Date achieved

*Event 1 classification - optional *For PARA applicants ONLY

Event 2

Date achieved - event 2

PB - event 2

*Event 2 classification - optional *For PARA applicants ONLY

Event 3

PB - event 3

Date achieved - event 3

*Event 3 classification - optional *For PARA applicants ONLY

Major achievements

Major swimming achievements

Other major achievements

General goals

Swimming

Other swimming goals

Education

Secondary school name

Year level achieved

Currently studying

Yes No

University/TAFE name - optional

Degree/course name - optional

Subject load (Full time or part time) - optional

Year level - optional e.g 2nd year

Other (please specify) - optional

Do you wish to enrol/transfer or explore options at UniSC?

Yes No

Further information

Work - optional Are you looking for work? Please specify what type of work

Qualifications - optional E.g. degree, first aid certificate

AWE - optional Do you currently interact with a PE Advisor? If so who?

Management company - optional Please provide company name and key contact's phone and email

Personal sponsors (if applicable) - optional

Why do you want to join the UniSC High performance swimming program?