Department of Education
SCHOOL SPORT NT VOLUNTEER REGISTRATION FORM 2018
(INCLUDING STUDENT OFFICIALS)
Volunteer Information
Given Name: / Family Name:Residential Address: / Postal Address:
Email Address: / Email Address (W):
Phone (BH) / Mobile Phone: / Phone (AH)
Teacher: Yes No / Teacher Registration Number and Expiry:
Related School: / Workplace: / Gender: Male Female
Ochre Card Number
(compulsory) / Exp
Date / Drivers Licence No:
Student Officials to complete the following:
Date of Birth: / Principal Authorisation
For Student to Officiate:
Medical Information
Emergency Contact Person: / Emergency Contact Phone:
Medicare Number: Exp Date:
Position on Card: / Medical Condition:
Additional Medical Details (including dietary):
Allergies: / Medication:
Private Health Fund Name:
Membership Number: / Date of Last Tetanus Injection:
I give permission for Convenors/Organisers to obtain medical / dental treatment for me if considered necessary. / Yes / No
I accept responsibility for any cost involved with medical or dental treatment I receive.
Event Information
Volunteer Category Adult / Event: / Dates: / Travel:
Air / Bus / Car
Level Of Competition: School Sport NT Event / Venue:
Role: Coach OR Manager
All Regional team members participating in the School Sport NT 12yrs & Under Championships for 2018 will be staying together in suitable accommodation with team officials for the duration of the Championship – this may be at a School Gym, Boarding College, Community Hall or other.
Permission Information (Please circle your choice)
I give permission for my photo and name to be listed on the School Sport NT website and other online environments for advertising and promotional purposes. / Yes / NoI am of Aboriginal or Torres Strait Islander origin. / Yes / No
Signed (by Parent if student official) Date: / /
The purpose for collecting this information is to ensure our Duty of Care to children when at a School Sport NT event is met. This information provided shall not knowingly be used for any other purpose that is reasonably with in our control.
DARWIN REGION SCHOOL SPORTNT
TEAM OFFICIAL APPLICATION FORM 2018
Additional Information for ______(insert name)
Positions applying for:
Preference / Sport / Age Group / Boys or Girls / Position1st / 12 / 15 / B / G / Coach / Manager
2nd / 12 / 15 / B / G / Coach / Manager
3rd / 12 / 15 / B / G / Coach / Manager
Relevant Qualifications/Experience:
Referees Names & Contact Numbers:
Name / Work Contact / Mobile ContactFor School Based Applicants:
Name of Event: ______
Date of Event: ______
Principals Endorsement: ______
DARWINREGION SCHOOL SPORT NT
TEAM OFFICIAL CRITERIA 2018
- Attend all days and nights (if travelling) of the School Sport NT Championship.
- Be prepared to stay with and supervise team members for the duration of the championship at nominated accommodation venue (may be a school gym, boarding college, community hall or other) – billeting will not be offered in 2018.
- Invitation to a Darwin Region School Sport team official evening and expectation to attend.
- Have a current Working with Children Ochre Card or willing to obtain one.
- Attend the Darwin Region Trials to select team members and reserves (see dates).
- Be prepared to coach/manage teams in accordance with guidelines and policies set out by the Darwin Region Management Board.
- Coordinate and conduct weekly training sessions for selected team members from trial date to event date (typically 8 weeks).
- Travel and meals (at team accommodation) will be provided for all travelling team officials – officials will be expected to assist with preparation of meals for team members staying in team accommodation.
- Participate in meetings and other as identified by School Sport NT for the Championship.
- Relief Teacher/School Staff reimbursement is available to schools.
- All successful applicants will be expected to attend a Mandatory Reporting Session prior to attending the championship/Development Camp.
I will abide by the above conditions if appointed as a Darwin Region School Sport NT team official.
I understand that Darwin Region School Sport NT will appoint officials in accordance with guidelines and policies set out by the Darwin Region Management Board and School Sport NT.
Signed: ______Date: ______
SCHOOL SPORT NT EVENT CALENDAR & DARWIN REGION SELECTION TRIALS 2018
12 Year and Under Championships
Dates / Sport / Venue / Darwin Region Trial DatesApril / 9 – 11 / Netball / Venue TBC - Barkly / Tues/Wed/Thurs
6 – 8 March
Sitzler Courts Marrara
(3.30 – 5.00pm)
May / 28 – 30 / AFL / Venue TBC - Alice Springs / Tues/Wed/Thurs
13 – 15 March
Sanderson Oval (3.30 – 5.00pm)
June / 18 – 20 / Boys Football (Soccer) / Venue TBC - Palmerston / Tues/Wed/Thurs
8 – 10 May
Larrakia Park(3.30 – 5.00pm)
June / 25 – 27 / Girls Football (Soccer) / Larrakia Stadium Darwin / Tues/Wed/Thurs
8 – 10 May
Larrakia Park (3.30 – 5.00pm)
12 Year and Under Development Camps
Dates / Sport / Venue / Darwin Region Trial DatesMay / 21 – 23 / Rugby League
Basketball / Venue TBC - Darwin
DBA Marrara / Tues/Wed/Thurs 10 – 12 April
Anula Oval (3.30 – 5.00pm)
Tues/Wed/Thurs 4 – 6 April
DBA Marrara (3.30 – 5.00pm)
June / 6 – 8 / Cricket
Tennis / MCG Darwin
Gardens Tennis Centre Darwin / Tues/Wed/Thurs 1 – 3 May
MCG Marrara (3.30 – 5.00pm)
Sun 29 April (8.30 – 10.00am)
Wed/Thurs 2 & 4 May
(3.30 – 5.00pm)
The Gardens Tennis Centre
Aug / 22 – 24 / Softball
Touch Football / Tracy Village
Venue TBC - Darwin / Fri 15/Sat 16/Mon 18 June
(5.30 – 6.30pm)Tracy Village
Tues/Wed/Thurs 12 – 14 June
Anula Oval(3.30 – 5.00pm)
Development/Selection Camps for 15/18/19 Years and Under
Dates / Sport / Self-Nominating Events – please encourage students to nominate by due dates – see School Sport NT Website or Facebook for more information / VenueApril / 27 – 29 / Australian Football
(15yrs Boys) / TIO Stadium
Darwin
May / 4 – 6 / Australian Football
(15yrs Girls) / TIO Stadium
Darwin
June / 1 – 3 / Netball (15yrs) / MIS
Darwin
June / 29 – July 1 / Touch (15yrs) / TBC
Darwin
Oct / 19 – 21 / Cricket (15yrs) / Marrara Cricket Grounds
Darwin
COMBINED DATES (10yrs - 19yrs)
Dates / Sport / VenueAug / 30 – Sept 1 / Track & Field (10-19yrs) / Arafura Athletics Stadium
Marrara