2018 GWA State Team Nomination Form

ACR Athlete State Team Nomination Form
Note to all Athlete Nominees:

As outlined in Newsletter 1, it is not yet confirmed whether Gymnastics WA will attend Australian Championships virtually, or in person and a decision is not expected until mid-March. If travelling to the event, the organising of all travel bookings will be responsibility of the individual and not Gymnastics WA. It should also be noted that Gymnastics WA will not cover any lost wages or costs incurred due to any quarantining requirements that may be in place upon your return to Perth after the event.

Due to the many uncertainties surrounding interstate travel, there will be a window of opportunity following the selection announcements for an athlete to withdraw / decline their position on the team, should you ultimately decide that you are not prepared to accept the risks associated with attending the event.
Full Name *

First Name Last Name
Club *
Athlete ID *
Date of Birth *
Phone *
Competitor Level *
Please select
Type *
Street Address *
Suburb & Postcode *
E-mail for all State Team Correspondence (must be parent email if under 18) *

Confirmation Email example@example.com
Parent / Guardian Name (if under 18)
Parent / Guardian Phone
Selection Committee Letter (if required)

State Team Policy 2021

The Gymnastics WA State Team Policy is unable to be updated for 2021 until a decision has been made in relation to travel for the WA State Team. In the interim, the 2020 can be used as a guide in so far as the selection process and criteria are concerned, however any sections relating to travel (i.e Underage Travel, Team Flights, Travel Arrangements, Accommodation, Travel Insurance) will be altered in the 2021 version which should be available at the end of March. All selected team members will be required to read through this new policy once it becomes available and in accepting your position on the team, you thereby agree to abide by the contents of the 2021 State Team Policy.
I have read and hereby agree to abide by the following Gymnastics WA policies *

Discipline & Appeals Policy Member Protection Policy Social Media Policy
I also hereby agree to the following *

Fulfil the Drugs in Sport Requirements Attend Meetings as required Attend all State Team training sessions
State Team Declaration

I wish to be considered for a place on the 2021 Gymnastics WA State Team to attend the Australian Championships and agree to the following State Team Declaration and Code of Conduct.

I understand that selection in the WA State team is based on meeting the selection criteria as specified in the Gymnastics WA State Team Policy.

If selected in the team, I agree to purchase all necessary items of the team uniform and wear them in accordance with Team Regulations.

I understand that selection on the team is dependent on the agreement to abide by the Gymnastics WA Member Protection Policy Part D: Code of Conduct and that breaches of the Code may result in disciplinary action.

I understand that once selected, I will need to comply with the terms and regulations outlined in the State Team Policy.

Should I need to withdraw from the team, I must notify Gymnastics WA immediately and submit a State Team Withdrawal form (accompanied by a Medical Certificate if the withdrawal is for medical reasons) to be able to put in an insurance claim. I understand that if I withdraw from the team, that I am still liable to pay any outstanding State Team accounts.

I understand that at the time that invoices are issued, I must be prepared to cover all costs associated with State Team travel. I am aware that if I do not pay the fees associated with selection on the State Team by the date specified on the respective invoice, that I will not be permitted to travel to Australian Championships.

I agree to abide by the ASADA Drugs in Sport requirements.

I also agree that Gymnastics WA or any team member associated with the Australian Gymnastics Championships shall not be deemed responsible or liable in any way for any injury, illness or other mishap to me / my child during the tour. I agree to be responsible for the costs of any medical treatment and ambulance deemed necessary by the Team Doctor and/or Head of Delegation.

I have read the specific Gymnastics WA policies listed below and understand that any breach of the rules could lead to me being ineligible for selection.

- State Team Policy (2021 version not available until end March)

- Discipline & Appeals Policy

- Member Protection Policy Part D (Code of Conduct)

- Social Media and Communications Policy
State Team Declaration Agreement

I / my child have read and agree to abide by the associated policies and documents as listed in the State Team Declaration.

State Team Medical Information

All members of the WA State team are required to complete medical forms. These forms will be distributed to successful team members shortly after selection and need to be returned to Gymnastics WA prior to travel. In the interim, to assist the selection committee please outline some basic medical information below.
Do you suffer from any medical conditions - physical or psychological *

Yes No
If Yes, please list details
Do you currently have a condition / illness / injury which is currently affecting your training? *

Yes No
If Yes, please list details
Thank you for completing a WA State Team Nomination Form. Please review the above information to ensure that all your details are correct. To complete your nomination and send off to Gymnastics WA, please click the 'Submit' button below. Once your form has been submitted, a copy of your nomination will be emailed to you by the Jotform program.
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ACR Athlete State Team Nomination Form