TOUCH 15 YEARS AND UNDER TRIALS NOMINATION FORM

In 2016the New South Wales Combined High Schools will be holding a selection trial for 15 years and under touch players on

Glen Willow playing fields in Mudgee on 30 April and 1 May 2016. The purpose of these trials is to select the NSWCHSSA team to play the Catholic and Independent Schools Touch teams in the NSW All Schools Touch Trials on Saturday 30and Sunday 31July 2016 at the Sydney Sports Academy, Narrabeen. At the conclusion of these trials a team will be selected to participate in the Boys and Girls School Sport Australia Touch Championships in Perth, Western Australia. The dates for the SSA Championships are 16-21October 2016. Sports Organisers and coaches are requested to nominate experienced touch players only and in the following manner.(1) Contact your Association Touch Convener to ascertain if your Association will be sending a team representing the Association.. Also find out the date of the Association Trials (if applicable and the closing date for nominations). (2) Nominate students who wish to be considered for the association team by sending in the form below to the association convener. (3) If your association is not organising a team, students may enter the trials individually by sending the completed form to the NSWCHSSA Touch Convener,Kelly Lawson (address details below). Further information regarding the touch selection trials is as follows:-

Please include a photocopy of your birth certificate with this form.

Please enclose a stamped self addressed envelope with this form.

Date of the Trials-30 April and 1st May 2016

Venue: Boys and Girls: Glen Willow Stadium and fields, Mudgee

Upon receipt of your nomination form you will be sent full information about the selection trials.

Registration fee is $36.00per player (please make cheques payable to NSWCHSSA).

Age:Students may turn 15 years of age or younger, in 2016. Students attaining the age of 16 years or over, in 2016 are not eligible.

Nominations are to be forwarded to either your Association Touch Convener where teams are organised on an Association basis or to the NSWCHSSA Touch Convener (individual nominations) along with a$36.00 entry fee. The Association Touch Convener’s address is found in the SSU Sports Directory. Kelly Lawson, the NSWCHS Touch Conveners address is:

NSWCHSSA Touch Convener

Wagga Wagga High SchoolFax :( 02) 69253611

Coleman St, Wagga Wagga NSW 2650.Ph: (02) 69255150

Nominations close 1 April 2016. Late entries will not be accepted.

Kelly Lawson

Touch Convener NSWCHSSA

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Please detach and return to the appropriate Touch Convener (see address above). A copy should also be sent to your Association Sports Coordination Officer for their information.

TOUCH GIRLS/BOYS 15 YEARS AND UNDER SELECTION TRIALS 2016 (Please print)

NAME:
HOME ADDRESS:
POSTCODE:
HOME PHONE NUMBER: ( )
AGE:DATE OF BIRTH:
MEDICARE NUMBER:
SCHOOL:
SCHOOL ADDRESS:
POSTCODE:
PRINCIPALS SIGNATURE:DATE:
Playing position (in order of preference) Middle/Link/Wing
1. / 2. / 3.
Experience (School and/or Association):

Important Information: In the event of injury, no personal injury insurance cover is provided by the NSW Department of Education for students in relation to school sporting activities, physical education lessons or any other school activity. The Department’s public liability cover is limited to breaches by the department in its duty of care to students that result in claims for compensation. Parents and caregivers are advised to assess the level and extent of their child’s involvement in the sport program offered by the school, school sport zone, association and state school sport associations when deciding whether additional insurance cover is required. Personal accident insurance cover is available through normal retail insurance outlets. Parents who have private ambulance cover need to check whether that cover extends tointerstate travel and make additional arrangements as considered appropriate. The NSW Supplementary Sporting Injury Benefits Scheme, funded by the NSW Government, provides limited cover for serious injury resulting in the permanent loss of a prescribed faculty or the use of some prescribed part of the body. The Supplementary Scheme does not cover medical expenses or dental costs .Further information can be obtained from Further information regarding student accident insurance and private health cover is provided at:

Publishing student information: The Department of Education may publish or disclose information about your child for the purposes of sharing his/her experiences with other students, informing the school and broader community.

This information may include your child’s name, age, information collected during this event such as photographs, sound & visual recordings of your child.

The communications in which your child’s information may be published or disclosed include but are not limited to:

  • Public websites of the Department of Education including the School Sport Unit website at

the Department of Education intranet(staff only), blogs and wikis

  • Department of Education publications including the school newsletter, annual school magazine and school report, promotional material published in print and electronically including on the Department’s websites
  • Official Department and school social media accounts on networks such as YouTube, Facebook and Twitter.
  • Local and metropolitan newspapers and magazines and other media outlets.
  • Parents should be aware that when information is published on public websites and social media channels it can be linked to by third parties and may be discoverable online for a number of years, if not permanently. Search engines may also cache or retain copies of published information.

Permission to publish: I have read the information about disclosing and publishing student information(above) and

I give permissionI do notgive permission

for the Department to publish and disclose information about my child in publiclyaccessible communications. This permission remains effective until I advise otherwise.

SIGNED: ______

Parent Consent:I hereby consent to my son/daughter participating in the NSWCHS 15 Years and Under Touch selection trials. I also consent to my child being administered medical treatment and authorise hospitalisation if deemed necessary by officials in the event that I cannot be contacted or an emergency situation arises.
PARENTS SIGNATURE:DATE: