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WESTERN AUSTRALIAN UNDERWATER HOCKEY
STATE TEAM NOMINATION PACK
IN THIS PACK
Brief Overview of the 2013 Australian UWH Nationals ................ 2
Nomination Information ................................................................ 3
Selections Information ................................................................... 4
Frequently Asked Questions .......................................................... 5
Important Dates ............................................................................. 6
Committee Contact List ................................................................. 6
Nomination Form (COMPLETE AND RETURN) ................................ 7
Code of Conduct Form (COMPLETE AND RETURN) ........................ 8
Medical Form (COMPLETE AND RETURN) ...................................... 9
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Brief Overview of the 2013 Australian UWH Nationals
LOCATION HOBART, TASMANIA
DATE 24-28 JANUARY 2013
COMPETITION VENUE HOBART AQUATIC CENTRE 1 DAVIES AVENUE QUEENS DOMAIN TAS 7000 (03)6222 6999
TEAM ACCOMMODATION QUEST TRINITY APARTMENTS
149 BROOKER AVENUE GLEBE TAS 7000
At this stage, costs are still to be determined.
Booking and paying for flights will be the responsibility of individual players.
All team members MUST be current members of the AUF http://auf.com.au/auf-membership/
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Nomination Information
PLEASE NOTE: YOUR FORM IS ONLY VALID IF… THE $100 NOMINATION ($20 NON-REFUNDABLE LANE HIRE) FEE HAS BEEN PAID
BEFORE COMMENCEMENT OF SELECTIONS.
IT IS ACCOMPANIED BY COMPLETED ‘MEDICAL’ AND ‘CODE OF CONDUCT’ FORMS
FILLING OUT YOUR FORMS NOMINATION PACK FORMS (NOMINATION, MEDICAL AND CODE OF CONDUCT)
MUST BE FILLED OUT AND RETURNED AT LEAST ONE WEEK PRIOR TO THE FIRST SELECTIONS.
(9TH SEPTEMBER 2012)
SPARE FORMS CAN BE OBTAINED FROM DISTRICT REPS AND STATE TEAM MANAGER
(PLEASE REFER TO COMMITTEE CONTACT LIST ATTACHED, PAGE 6)
RETURNING YOUR FORMS PLEASE RETURN FORMS TO EITHER…
- YOUR DISTRICT REPRESENTATIVE
- THE STATE TEAM MANAGER (PLEASE REFER TO COMMITTEE CONTACT LIST ATTACHED, PAGE 6)
MAKING YOUR PAYMENT $100 ($20 NON-REFUNDABLE LANE HIRE) TO AVOID CONFUSION, PLEASE ENDEAVOUR TO FINALISE YOUR NOMINATION FEE PRIOR TO FIRST
SELECTIONS (16TH SEPTEMBER 2012)
PAYMENTS CAN BE MADE IN THE FOLLOWING WAY…. ONLINE OR AT THE BANK: ACC NAME: UWH STATE TEAM
BSB: 086 006 ACC: 607 058 305 DETAILS: YOUR NAME
BY CHEQUE: MAKE CHEQUE OUT TO ‘UWH STATE TEAM’ POST: WA UWH STATE TEAM MANAGER
LEE-MAREE STINSON
9 PIONEER COURT, SAMSON WA 6163
…OR PAY ON THE DAY TO TEAM MANAGER: LEE-MAREE STINSON
* NOTE: IF YOU ARE UNSUCCESSFUL IN THE STATE SELECTIONS, YOU WILL BE REFUNDED $80 OF THE NOMINATION
FEE. ($20 WILL BE KEPT FOR LANE HIRE)
THE AGE CUT-OFF DATE FOR TEAMS IS THE 1ST JANUARY 2013
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Selections Information
CONFIRMED SELECTION DATES
- 16TH SEPTEMBER 2012 – BELMONT OASIS – 10:30AM TIL 4:00PM
(ALEXANDER ROAD, BELMONT)
- 14TH OCTOBER 2012 – CHALLENGE STADIUM – 11:00AM TIL 4:00PM
(100 STEPHENSON AVENUE, MOUNT CLAREMONT)
BRING A CHEERY DISPOSITION
AVOID EATING THE PUCK
TRY YOUR DARNDEST
PLEASE MAKE SURE YOU GET TO THE POOL HALF AN HOUR EARLY IF YOU HAVE TO PAY YOUR NOMINATION FEE ON THE DAY…
…I’M SURE NO ONE WILL HAVE TO THOUGH… …I’M CERTAIN EVERYONE WILL DO THE RIGHT THING AND ORGANISE PAYMENT
AND FORMS BEFORE SELECTION DAY.
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Frequently Asked Questions
Q. I can make it to only one of the selection dates, can I still be considered? A. Yes, still complete your nomination pack (All forms and fee payment). Please be aware though, those
attending both dates may have the advantage at time of selection.
Q. I can’t make it to any of the selection dates, can I still be considered? A. No, sorry… Just kidding, of course you can! Just make sure you still complete your nomination pack (All forms and fee payment). Please be aware though, those attending may have the advantage at time of selection.
Q. If I make the team, can my family travel and stay with me? A. Yes. If you make the team, be sure to inform the team manager as soon as possible. Rooms reserved
for family/partners are limited and will become occupied fast.
Q. Can I fundraise? A. Definitely!
Q. Just how much do you think this will cost me? A. At this stage cost are still to be determined. We can only estimate at this stage. The competition may
cost approx. $1000 per player, depending on our arrangements and Tasmanian fees. This will include 5
nights accommodation, transport(which will most likely be minimal due to the fact the pool is within
walking distance of the accommodation), uniforms, competition fees, presentation night ticket,
manager, chaperone and coach contributions, and pool entrance for training in the lead-up to Nationals.
Costs, as always, will be as low as possible.
NOTE: This DOES NOT include airfares. Players arrange their own airfares.
Q. Someone told me it was dangerous for my health to attend the SNR presentation night, is that true? A. Never, it’s usually a quiet affair, scones and tea, perhaps the odd cucumber sandwich.
Q. So, how many forms am I filling out to do this nomination thingo? A. Three, a nomination form, a medical form and a code of conduct form…All contained in this pack.
Q. My dog ate one of my forms…How do I get another one? A. You can obtain more forms by requesting one via email(see contact list), pick up one from the WA
Underwater Hockey Facebook page or the WA Underwater Hockey website or see your district rep/team
manager (again, see contact list).
Q. Do I really have to be a member of the AUF? A. Yes, if you’re not, you cannot play.
Q. I’m turning 19 next year, but not until June, can I still be part of the U19’s team? A. Yes, The cut-off date for ages is 1st January 2013. This applies to all teams with age requirements.
IF YOU HAVE ANY OTHER QUESTIONS PLEASE DIRECT THEM TO YOUR DIVISION REPRESENTATIVE OR
THE STATE TEAM MANAGER.
(PLEASE REFER TO COMMITTEE CONTACT LIST PAGE 6)
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Important Dates
9TH SEPTEMBER 2012
15TH
SEPTEMBER 2012
16TH SEPTEMBER 2012
18TH
OCTOBER 2012
1ST JANUARY 2013
23RD
JANUARY 2013
24TH JANUARY 2013
28TH
JANUARY 2013
29TH JANUARY 2012
FINAL DAY TO RETURN NOMINATIONS FORM NOMINATION FEE BEFORE THIS DATE FIRST STATE TRIALS SECOND STATE TRIALS AGE CUT-OFF DATE FIRST DAY OF TEAM ACCOMMODATION FIRST DAY OF NATIONALS FINAL DAY OF NATIONALS FINAL DAY OF TEAM ACCOMMODATION
Committee Contact List
State President Perth Representative
Craig Mackenzie 0419 927 577 [email protected]
State Treasurer
Collie Representative Jenny Griffiths 0427 345 539
State Team Manager
Lee-Maree Stinson 0428 240 681 (08) 9337 8032 [email protected]
Bunbury Representative TBA Enquire with State Team Manager
Margaret River Representative Chris Wenman
Clare Forward
0404 046 059 [email protected] 0417 345 033 [email protected]
Perth Representative Greg Stinson 0458 908 128
(08) 9337 8032 [email protected]
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2013 WA UWH STATE TEAM NOMINATION FORM
APPLICANT INFORMATION
Surname: Given Names:
Date of Birth: / / Email:
Phone: Mobile: Work:
Current Address:
Postcode:
Postal Address (Leave blank if same as above):
Postcode:
TEAM/S OF NOMINATION
Please indicate the team/s you are nominating for. If you are nominating for more than one team, ‘X’ more than one box. Then indicate your preferences by numbering your nominations. 1 being your first preference.
Indicate your nomination with an ‘X’ TEAM Order of preference
(Only use if nominating for more than one team)
U15’s
U19’s Women’s Men’s Masters
EMERGENCY CONTACT
Surname: Given Names:
Relationship: Email:
Phone: Mobile: Work:
Address:
Postcode:
SIGNATURES
If you are under the age of 18 years you must have your parent or guardian sign your nomination
form.
Signature of applicant:
Date:
As the parent or legal guardian of the child named above, I give my permission for my child to nominate for the
WA state team specified above.
Name of Parent or Guardian:
Signature of Parent or Guardian:
Date:
PAYMENT OF NOMINATION FEE
This form is ONLY VALID if the nomination fee has been paid BEFORE commencement of selections. Nomination Fee: $100 ($20 is non-refundable lane hire)
PAY ONLINE
ACC NAME: UWH STATE TEAM BSB: 086 006 ACC: 607 058 305 DETAILS: YOUR NAME
PAY BY CHEQUE
MAKE CHEQUE OUT TO ‘UWH STATE TEAM’
POST: WA UWH STATE TEAM MANAGER LEE-MAREE STINSON 9 PIONEER COURT, SAMSON WA 6163
…OR PAY ON THE DAY TO TEAM MANAGER: LEE-MAREE STINSON
OFFICE USE:
PAYMENT RECEIVED BY: __________________ DATE: / / SIGNATURE OF RECIEVEE:
PAID: CASH CHEQUE BANK TRANSFER OTHER_______________
! AGE CUT-OFF DATE ! 1st January 2013
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WESTERN AUSTRALIAN UNDERWATER WATER HOCKEY TEAM PLAYERS AND TEAM MANAGEMENT CODE OF CONDUCT
Name: ____________________________________ Date of Birth: _______________________
THE UNDERSIGNED AGREES TO THE ITEMS LISTED BELOW: 1. All players must be current FULL members of the Australian Underwater Federation Inc. 2. All payment for airfares, accommodation, uniforms, administration fees and Coach’s fees must be paid
to the Team Manager by the due dates, as specified by the Team Manager in order to compete. 3. Players must return and/or respond to all correspondence on or before the due date, as specified in the
correspondence by the team coach or Team Manager. 4. All players are responsible to the Management Team, consisting of the Team Manager and team
coaches. In addition junior players are responsible to the Juniors’ Chaperone. 5. All laws of any country, State or Territory that a team is visiting must be adhered to in full. 6. All rules of venues being used by the team and regulations of the host organisation must be adhered to
in full. 7. Players and officials of the Management Team must not attend training, competition or meetings whilst
intoxicated. In particular note that the drinking of alcohol by any juniors will not be tolerated at any stage during the official tour. The drinking of alcohol by seniors during the tour is not encouraged and supplying alcohol to juniors is forbidden.
8. Players and officials must not behave in such a way as to bring criticism to the touring party, underwater hockey or their State.
9. Players and officials must comply with uniform dress code requirements as set by the Team Management.
10. Players must attempt to maintain themselves in peak mental and physical condition during training and competition.
11. Players must abide by the Australian Sports Drug Code. 12. Any illness or injury must be reported to the team’s coach and/or Team Management as soon as
possible. 13. The Team Manager has the authority to seek medical attention for and on behalf of the players, if the
Team Manager considers it necessary in the circumstances. 14. Players must attend all training sessions when and where reasonably required. 15. Players must abide by training programs set by the team’s coach. 16. Individual sponsorship can only be displayed when permission has been granted by the Team
Management. 17. Prior to any comment being made to the media by any team player, permission must be obtained from
the Team Management 18. This code of conduct extends to all members of all the Western Australian underwater hockey teams,
including players, Team Management and Juniors’ Chaperone 19. If any party breaches this code of conduct, then such breach may lead to either temporary or permanent
expulsion from the team, subject to review, to be decided by a committee of the Team Management. Signed: ___________________________ Date: ________________ (Player) Signed: ___________________________ Date: ________________ (Parent/Guardian (If Player is under 18 years)) Signed: ___________________________ Date: ________________ (Witness)
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2013 WA UWH STATE TEAM MEDICAL FORM
APPLICANT INFORMATION
Surname: Given Names:
Date of Birth: / / Gender M / F Email:
Phone: Mobile: Work:
Current Address:
Postcode:
Postal Address (Leave blank if same as above):
Postcode:
HEALTHCARE DETAILS
Medicare number:
Doctors Practice Doctors name: Ph:
Address:
Dental Practice: Dentists name: Ph:
Address:
Private Healthcare? No Yes Fund: Member Number:
EMERGENCY CONTACT
Surname: Given Names:
Relationship: Email:
Phone: Mobile: Work:
Address:
Postcode:
MEDICAL INFORMATION
Blood group: Do you object to transfusions? yes / no (please circle)
Have you received a medical clearance from your doctor? yes / no (please circle)
Do you have any allergies? yes / no (please circle) If yes, please list:
Please list any medical conditions that you have (for example, asthma, diabetes, epilepsy):
Please list any regular medications you require (include dosage):
SIGNATURES
To the best of my knowledge, all information contained on this form is correct (if under 18 please have a parent or guardian sign)
Name:
Signature:
Date:
