Date of Birth*

Gender* Please select... Female Male Non-binary Not listed Prefer not to say

Do you identify as Aboriginal and/or Torres Strait Islander?* Please select... Yes No

Are you an Australian citizen?*

Is the athlete under the age of 18?* Please select... Yes No

Parent/Guardian name*

Parent/Guardian email*

Parent/Guardian phone*

If you are comfortable, please tell us a bit more about your disability and how you think it impacts you. (Where comfortable, please provide as much detail as possible, i.e. underlying medical diagnosis/health and/or your level of function or movement* Max 255 characters

Nature of impairment (if relevant)*

Use of mobility aid Multiple choice (select all that apply):*

List any care support requirements, level of independence, other accessibility requirements (e.g. in personal care, travel, sports facilities, or technology)* Max 255 characters

Are you, or have you ever been classified in a Para sport?* Please select... Yes No Unsure

Tell us which Para sport(s), which class, and when you were last classified* Max 255 characters

Who referred you to the NSWIS Para Unit? (Single choice)* Please select... Wheelchair Sports NSW/ACT NSW Institute of Sport Rehabilitation centre Health or disability professional Teacher or school Other athlete Other website or social media

Tell us about your current interest or future goal(s) in Para sport* Please select... I'm looking to learn about and be active in Para sport for the first time I'm looking for a Para sport in which I can compete I'm already a competitive athlete and I'm looking to get into high performance Para sport

Which Para sports are you interested in? (select all that apply)*

Please advise of your shirt sizing below (Kids and Unisex Sizing). Single choice:*

Details of current health care providers * Please provide a contact name, email and number of your medical practitioner, along with physiotherapist, occupational therapist (if any)* Max 255 characters

Details of emergency contact * Please provide a contact name and number for any emergencies (this person cannot be a participant in the same program).* Max 255 characters

I understand that NSWIS Para Unit activities may require a maximal physical exertion and if I feel I cannot complete the task safely I will inform the responsible NSWIS staff. * This applies to both before or during the prescribed activity.* Please select... Yes No

Health & Medical Information List any current injury and/or medical illness that would impact your participation in NSWIS Para Unit activities?* Max 255 characters

Do you experience seizures? * Single choice:* Please select... Yes and will upload my send my management plan to para.unit@nswis.com.au No

List any allergies* Max 255 characters

I will provide information about any medical conditions that may arise in the future and affect my ability to safely participate in NSWIS Para Unit activities.* Please select... Yes No

List any dietary requirements* Max 255 characters

Privacy Statement: I consent to NSWIS collecting and holding my personal information and its disclosure with potential project partners* Please select... Yes No

I would like to receive updates from NSWIS. I understand that they may send me information from time to time. I may unsubscribe at any time, and my data will be treated in accordance with NSWIS Privacy Policy?* Please select... Yes No

Activity Consent * By completing the form, I accept all risks associated to my undertaking in physical activity and sport, and indemnify NSWIS from any liability, damage, loss, costs, expenses and otherwise incurred as a result of any injury or illness.* Please select... Yes No