Thank You for Downloading the Nomination Pack for the 2009 World University Winter Games

Thank you for downloading the nomination pack for the 2009 World University Winter Games. Enclosed within this pack you will find all of the required documents for your nomination for selection for the 2009 Games.

Please ensure that you read all of the information carefully and complete ALL of the required paperwork CORRECTLY. If you have any queries about the paperwork please contact the BUCS office on 020 7633 5080. We have included a check list to help you to ensure that you return all of the relevant documents to the BUCS office. If paperwork is returned to the Office incomplete you will be informed by email what information is missing and asked to complete it as soon as possible. If all of your paperwork has been completed correctly you will receive an email from us confirming receipt of the information.

PLEASE NOTE YOU WILL NOT BE CONSIDERED FOR SELECTION UNTIL ALL OF THE REQUIRED PAPERWORK HAS BEEN CORRECTLY COMPLETED AND RETURNED TO THE BUCS OFFICE.

The majority of future correspondence with you will be via email, therefore please ensure that you give us your correct email address being careful about whether it is a .com or .co.uk address

Further details pertaining to the Games can be found at www.bucs.org.uk/Harbin2009 and you should check this website for regular updates and further specific information for the travelling delegation or the organising committee’s website www.harbin2009.org

Jo Kirk

Head of Development and International Programmes

Please complete and return ALL of the paperwork listed below and tick the relevant boxes to confirm that the paperwork is included within the envelope.

Nomination Form
Please note this MUST be signed by AU President / Sport Officer /
Copy of back page of passport
If selected your passport will be required at a later date for visa purposes /
Certificate of Academic Eligibility / Graduation Certificate
CURRENT STUDENTS - Section 2 needs to be completed by a senior member of the university’s Registry Office or equivalent and NOT a member of the Athletic Union / Students Union or Sports Department. The institution stamp that is required should be the full and formal university stamp and not a students’ union / athletic union stamp. The university must also sign the reverse of the form to confirm that you meet the eligibility criteria.
ONE YEAR DOWN STUDENTS
If you are a ‘One Year Down’ student (i.e. you graduated in 2008) please send a photocopy of your Graduation Certificate to the BUCS Office. You do not need to complete a Certificate of Academic Eligibility. /
Passport Photos x4
Please write your name on the back of ALL photos (these must have a white background) /
Medical Form
Please include a copy your aTUE/TUE if applicable /
TUE (if applicable) /
Physiotherapy Form & Injuryzone Consent Form /
Press Form /
Chinese Visa Application /

I confirm that I have sent all of the above paperwork to the BUCS Office, 20 – 24 King’s Bench Street, London, SE1 0QX

Upon selection I acknowledge that I will be required to pay a personal contribution of £580 and sign a Team Members Agreement

Name / Signature
Date

OFFICE USE ONLY Date Received Checked

Input onto Database Requested additional information

COMPETITOR NOMINATION FORM

Event / Sport: WORLD UNIVERSITY WINTER GAMES 2009 – CURLING

All fields are mandatory, complete in block capital letters and enclose a copy of the back page of your passport

PERSONAL DETAILS

Name as per passport:
Postal Address:
Post Code:
Email:
Mobile Number:
Home / Work Number:

PASSPORT DETAILS

Passport Number:
Expiry Date *
Date of Birth
Place of Birth

*you must have at least 6 months remaining on your passport to be able to travel

UNIVERSITY DETAILS

University:
Course:
Start Date:
Finish Date:

KIT SIZES

Leisurewear kit will be supplied by Nike

XS (34/36) / L (41/43)
S (36/38) / XL (44/46)
M (38/40) / Height
Shoe Size

DIETARY REQUIREMENTS

Vegetarian / Other
Signature:
Date:

ELIGIBILITY REQUIREMENTS

BUCS currently applies the following regulations when selecting representative teams to participate in FISU competitions:

a) FISU Regulations 5.2.1

Only the following may participate as competitors in a FISU Sporting Event:

i) Students who are currently officially registered as proceeding towards a degree or diploma at the university or similar institute whose status is recognised by the appropriate national academic authority of their country (e.g. the Department of Education in the UK).

ii) Former students of the institutions mentioned in (i) who have obtained their academic degree/diploma in the year preceding the event.

b) FISU Regulations 5.2.3

All competitors must satisfy the following conditions.

i) be a national of the country they represent (therefore hold a full 10 year UK passport)

ii) be at least 17 and less than 28 years of age on January 1st in the year of the event (born between 1 January 1981 and 31 December 1991)

c) Students studying abroad are eligible for selection provided they satisfy FISU regulations 5.2.1 and 5.2.3

d) Students attending courses franchised out from an institution [complying with FISU Regulations 5.2.1 (i)] are eligible for selection providing they also satisfy FISU Regulation 5.2.3.

WARNING

The information given overleaf must be accurate and to the best of the signatories knowledge at the date indicated below. Action will be taken against anyone falsifying information or wilfully misleading BUCS. Should any information change, please inform the Organising Secretary immediately. Please ensure that you have read and understood the Eligibility Requirements.

We certify that the above information is correct and have read the regulations regarding eligibility.

Signed: Signed:

(Athlete) (AU President / Sports Officer)

Name (print): Name:

Date: Date:

Certificate of Academic Eligibility

Event / Sport: WORLD UNIVERSITY WINTER GAMES 2009 – CURLING

1. To be completed by competitor (in block capital letters)

Name as per Passport
UK Passport Number & Name of Issuing Office:
Place of Birth: / Date of Birth:
Institution: / Name & Title Degree:
Humanities / Science / Physical Education / Other Studies (delete as appropriate):
Course Commenced (date): / Course Ends (date):

2. To be completed by Institution Official (please turn over and sign the eligibility regulations)

I certify to the best of my knowledge that the above Academic Record is correct

Signed: / Print Name:
Position in Institution: / Date:

Photograph of Competitor Official Institution Stamp

(This must be the official stamp of the institution, not the Student / Athletic Union stamp)

ELIGIBILITY REQUIREMENTS

BUCS currently applies the following regulations when selecting representative teams to participate in FISU competitions:

a) FISU Regulations 5.2.1

Only the following may participate as competitors in a FISU Sporting Event:

i) Students who are currently officially registered as proceeding towards a degree or diploma at the university or similar institute whose status is recognised by the appropriate national academic authority of their country (e.g. the Department of Education in the UK).

ii) Former students of the institutions mentioned in (i) who have obtained their academic degree/diploma in the year preceding the event.

b) FISU Regulations 5.2.3

All competitors must satisfy the following conditions.

i) be a national of the country they represent (therefore hold a full 10 year UK passport)

ii) be at least 17 and less than 28 years of age on January 1st in the year of the event (born between 1 January 1981 and 31 December 1991)

c) Students studying abroad are eligible for selection provided they satisfy FISU regulations 5.2.1 and 5.2.3

d) Students attending courses franchised out from an institution [complying with FISU Regulations 5.2.1 (i)] are eligible for selection providing they also satisfy FISU Regulation 5.2.3.

WARNING

The information given overleaf must be accurate and to the best of the signatories knowledge at the date indicated below. Action will be taken against anyone falsifying information or wilfully misleading BUCS. Should any information change, please inform the Organising Secretary immediately. Please ensure that you have read and understood the Eligibility Requirements.

We certify that the above information is correct and have read the regulations regarding eligibility.

Signed: Signed:

(Athlete) (AU President / Sports Officer)

Name (print): Name:

Date: Date:

World University Winter Games

Harbin 2009

Confidential Medical Questionnaire

PLEASE COMPLETE CLEARLY IN BLOCK CAPITAL LETTERS

SPORT
Name
Date of Birth
Address
E-mail
Contact Tel Number
GP / Doctors Name, Address & Telephone number. Hospital Number if under hospital care.
NGB Doctor’s name/ e-mail address & contact number
Two Next of Kin Contact Details: Address and Telephone Number
1. Name:
Address:
Tel: / 2. Name
Address:
Tel:

Please List / Describe all serious old, chronic or existing injuries

1)
2)
3)
4)
5)
Please describe all serious illness or chronic medical conditions e.g. asthma, diabetes, high blood pressure, migraines, epilepsy. Also please list all previous operations e.g. appendix etc.
1)
2)
3)
4)
Allergies or Sensitivities

Blood Group. If you are able to trace your blood group this is extremely important information.

YES / NO / Details
Have you had a Dentist Appointment in the last year? (if no please arrange a dental check)
List recent acute illnesses in the last year. / YES / NO / Dates
Sore throat / cough / cold
Ear infection
Other infections or explained fever
Headaches
Diarrhoea and /or vomiting
Abdominal pain

Travel Abroad

/ YES / NO / Date/Details

Foreign trips this year

Problems with jet lag?

Travel sickness

Insomnia

Immunisations / YES / NO / Dates

Tetanus

Polio

Diptheria

Hep A

Hep B

MMR

Typhoid

/ YES / NO / Details

Have you previously used any travel medication

Days missed from training in last year due to:

Illness

Injury

Travel

Have you any recent episodes of:

/ YES / NO / Details

Palpitations

Dizziness

Chest pain

Shortness of breath

Loss of Consciousness/Collapse

Intolerance of heat

Abnormal fatigue

Gynaecological or Pelvic Problems

Abnormal muscle pain, cramps, stiffness

Please List ALL regular or one-off Medications and any Supplements taken over the last 3 months

Name / Dose / Frequency / Reason for Taking / Last taken / Tested ?
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
Please list details of drug testing at home and abroad in the last 6 months and their results if known.
1)
2)
3)
4)
Current aTUE/ TUE (Therapeutic Use Exemption) certificates:
Substance / Dose / Method of administration / Date submitted / Expiry Date / Granted by
Eg salbutamol / 100mcg / Inhalation 2puffs as nec / 10/6/07 / 31.5.09 / UKSport

FAILURE TO DECLARE A BANNED SUBSTANCE EVEN IF TAKEN AS CORRECT TREATMENT CAN RESULT IN A POSITIVE DOPING TEST

Please enclose a copy of current aTUE/TUE if applicable

Please use this space to provide any additional information that you feel is relevant.

I hereby confirm that the information above is accurate and complete. I confirm that I am not taking any banned substances and I will not take any medication or supplements during the games without first consulting a member of the medical team. All information contained herein is confidential and will only be available to the medical team. I also agree in the case of emergency that information can be obtained from my doctor at home.

Signature Date

Please complete and return by 31 December 2008 to:

Harriet Collins, c/o BUCS, 20 – 24 King’s Bench Street, London, SE1 0QX

If, after completing this form, you become ill or injured, please update your team manager and the Chief Medical Officer, Harriet Collins at or via the BUCS Office 0207 633 5080

World University Winter Games

Harbin 2009

Confidential Physiotherapy Questionnaire

PLEASE COMPLETE CLEARLY IN BLOCK CAPITAL LETTERS

SPORT
EVENT
Name:
Address:
Telephone number - / Daytime: / Evening:
E-mail address
Date of birth:
Event:
YES / NO
Have you suffered from any injuries during the past six months?
If yes, did you attend a physiotherapist, doctor or hospital for treatment?
Please give a written description of the injury (including the location and type of injury) and any treatment received
YES / NO
Are you still under the care of a physiotherapist, doctor or hospital?
If yes, what treatment are you currently receiving?
Please describe your current symptoms.
YES / NO
Do your current symptoms restrict your sporting activity?
Do you have any other ongoing injuries that you have not already mentioned?
If yes can you describe them, including how long they have been present and the treatment you are receiving for them.
If you are currently attending for physiotherapy treatment, please ask your physiotherapist to provide a brief report of your condition and treatment and return it with this form. Please provide their contact details below:
Name
Email Address
Tel No

Injury Zone

This is a web based, secure, system of recording medical and physiotherapy records. Funded athletes in the UK usually have their notes recorded on injury zone. During the World University Games we would like to record all medical records using this system. Please indicate below if your medical and physio notes are already stored on injury zone.

YES / NO

If not, please read the injury zone information sheet below after which we hope you will agree to have your notes recorded using the system.

Signed: Date:

InjuryZone - Guidance Note for Athletes