Active Fest Registration 1Applicant Details2Sporting Achievement Details3Athlete Medical Form4Parent/Guardian Information5Agreements HiddenGroups* Active Fest First Name* Family Name* Email* Enter Email Confirm Email Street Address* Town* Postcode* Date of Birth* MM slash DD slash YYYY Gender* Male Female Gender Neutral Home Phone Mobile Phone* ATSI-Diverse Background Yes No Are you of Aboriginal and Torres Strait Island background? This information is used for NCAS and NSW Government - Office of Sport reporting requirementsCALD - Culturally and Linguistically Diverse Yes No Are you of a culturally or linguistically diverse background? This information is used for NCAS and NSW Government – Office of Sport reporting requirementsSchool What Sports do you Play? What Sports are you Interested in? HiddenHome Club & Association HiddenMembership Number e.g. Netball NSW / Basketball NSW / Golf Link etc.HiddenPlaying Positions Athlete Medical FormComplete the medical information below. Complete the medical information below. NCAS treats this information as confidential and is bound by its privacy policy. NCAS will only distribute this information to those people whom we consider need it to ensure your health and well-being at NCAS events. The medical information provided within this document will be used throughout the associated NCAS Trials and subsequent Program should the athlete be accepted. Please contact NCAS as soon as possible if athlete medical information changes. Medicare Number* Do you have private medical cover?* Yes No If yes, state provider and policy numberDo you have ambulance cover?* Yes No Date of last tetanus injection DD slash MM slash YYYY Blood type*Please chooseDon't knowO negativeO positiveA negativeA positiveB negativeB positiveAB negativeAB positiveDo you suffer from asthma?* Yes No If yes, detail your asthma treatment planDo you suffer from diabetes?* Yes No If yes, detail your diabetes treatment planDo you suffer from epilepsy or similar episodes?* Yes No If yes, detail your epilepsy, or other treatment planDo you suffer from allergies (foods, medications, stings etc)?*Detail below please.Do you have any specific food requirements (gluten free, vegetarian, vegan etc)* Yes No If yes, detail your specific food requirements below:List any other personal medications and the reasons for their use.List all other medical / health related matter/s not already mentioned that NCAS should be made aware of as well their related treatment plan/sDetails all significant injuries and treatments over the past 12 months. Parent/Guardian InformationParent/Guardian 1Parent/Guardian 1 Name* Parent/Guardian 1 Phone* Parent/Guardian 1 Email* Parent/Guardian 2Parent/Guardian 2 Name* Parent/Guardian 2 Phone* Parent/Guardian 2 Email* Other Emergency ContactsOther Emergency Contact People & Contact Number Athlete Declaration & Parental/Guardian ConsentAthlete Declaration* The information I have provided is accurate and correct Parental/Guardian Consent* I consent to, and confirm, that my child is fit to participate in all Active Fest activities EmailThis field is for validation purposes and should be left unchanged.
