Eligibility Form - Sport Inclusion Australia

Step 1 of 6

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What level of sport?(Required)

School Sport

National Sport

International Sport

School Sport

School sport definition

National Sport

National Sport definition

International Sport

International Sport Definition

Athlete Level of Eligibility

Sport Inclusion Australia follows the Virtus eligibility categories for intellectual impairment (II), grouped as II-1, II-2 & II-3.

II-1

II-2

II-3

II-1

Athletes with an intellectual disability

II-2

Athletes with an intellectual disability and significant additional impairment

II-3

Athletes with autism

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Which type of elegibility form are you submitting? (select one)(Required)

School Sport – II1 (Intellectual Disability)

School Sport – II2 (Significant Additional Impairment)

School Sport – II3 (Autism)

National – II1 (Intellectual Disability)

National- II2 (Significant Additional Impairment)

National – II3 (Autism)

International (Virtus) – II1 (Intellectual Disability)

International (Virtus)- II2 (Significant Additional Impairment)

International (Virtus) – II3 (Autism)

Unique ID

Athlete’s Name(Required)

Tooltip information

First Last

Date of Birth(Required)

Day

Month

Year

Gender (as stated on passport)(Required)

Nationality(Required)

Please upload a passport size photo here(Required)

Drop files here or

Max. file size: 32 MB.

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Who is completing this form?

First Last

Relationship to Athlete(Required)

Phone(Required)

Email(Required)

Sport(s) in which the athlete will complete

AFL

Alpine skiing

Athletics

Basketball

Cricket/Indoor Cricket

Cycling

Futsal

Golf

Judo

Netball

Rowing/Indoor Rowing

Soccer

Table Tennis

Tennis

Tenpin Bowling

Triathlon

Swimming

Other

ATHLETE DECLARATION (All Athletes must complete, by checking each box and signing below). By signing this declaration I am saying that:(Required)

I understand the eligibility criteria to compete as an athlete with intellectual disability.

I give Sport Inclusion Australia permission to use information in accordance with the Sport Inclusion Australia Data Protection and Information Handling Policy.

I give Sport Inclusion Australia permission to use this information to decide whether I am a person with intellectual disability for eligibility and sports classification, and to share this information with relevant organisations, including but not limited to National Sport Organisations.

As far as I know, all the information in my application is true and accurate.

I understand what the information in this form is being used for, or I have had this explained to me.

Athlete's Name(Required)

Date(Required)

DD slash MM slash YYYY

PARENT OR LEGAL GUARDIAN (only if the athlete is under 18 or over 18 and without legal capacity to give consent)(Required)

By signing this declaration I am saying that the athlete named above is less than 18 years or without legal capacity to sign on their own behalf. I understand the above declarations and have the legal right to sign on behalf of this person.

Parent or Legal Guardian's Name

Relationship to Athlete

Date

DD slash MM slash YYYY

ATHLETE DECLARATION (All Athletes must complete, by checking each box and signing below). By signing this declaration I am saying that:(Required)

I understand and comply with the eligibility criteria to compete as an athlete with intellectual impairment.

I confirm that I shall comply with all Virtus policies and procedures, including but not limited to all provisions of the Anti-Doping Policy, all amendments to the Anti-Doping Rules, and all International Standards as issued by the World Anti-Doping Agency and permanently published on its website. I acknowledge that National Federations, Virtus, and National Anti-Doping Organisations have jurisdiction to impose sanctions as provided in the Anti-Doping Rules.

I give Virtus permission to hold information electronically and to use information in accordance with the Privacy Policy. I agree that in order to maintain the principles of fair eligibility and classification, Virtus may retain relevant and essential information indefinitely.

I understand and agree to uphold the principles of the Virtus Code of Ethics and the spirit of fair play.

I agree to Virtus using photographs and images of me for the purposes of publicity in print, electronic, and other media, and can withdraw this consent at any time by writing to the Secretariat.

I agree that data I have provided can be used for research purposes, as set out under the Virtus research code, and this data will not identify me individually and will be managed under the Virtus Privacy Policy.

I give Virtus permission to use this information to decide whether I am a person with intellectual impairment for eligibility and sports classification, and to share this information with relevant organisations, including but not limited to the IPC and International Federations.

I understand the risks associated with competition and that I am responsible for my actions at all times.

As far as I know, all the information in my application is true and accurate.

I understand what the information in this form is being used for, or I have had this explained to me.

Athlete's Name(Required)

Date(Required)

DD slash MM slash YYYY

PARENT OR LEGAL GUARDIAN (only if the athlete is under 18 or over 18 and without legal capacity to give consent)(Required)

Parent or Legal Guardian's Name

Relationship to Athlete

Date

DD slash MM slash YYYY

School Sport – II1 (Intellectual Disability)

Primary Eligibility	Actions

There are no Entries.

Maximum number of entries reached.

National – II1 (Intellectual Disability)

Primary Eligibility	Actions

There are no Entries.

Maximum number of entries reached.