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DATE RECEIVED ......................... DATE ACCEPTED ......................... Athlete Details Personal Details Name……………………………………………………….. DOB:……………………………… Male/Female Age now........................... Home address: Address (University/College) ……………………………………………………….. ………………………………………………………… …………………………………………………….…. ……………………………………………………….. ……………………………………………………….. ………………………………………………………… Post code …………………………………….…. Post code ………………………………………… Phone No. Home: …………………………... Mobile: …………………………………………… Email Address:…………………………… @ ………………………………………………………………………………….. Passport: British/Other (please state) ................................................................ Anthropometric and Performance details British Rowing No:…………………….. Points: Rowing............. Sculling................. Bow side/ Stroke side (please circle) Height:……………….metres Armspan:…………..…metres Weight:…………………kg Ergo Scores: 2K (total) ……min. ….sec 5K (split): ……..min…….sec 30’(split)…….min…….sec Extra Information Current club/university/school:................................................................................................ How long have you been in the sport:.........months...............years What year did you start rowing:....................... Do you have your own single scull: Y/N Do you have your own blades: Y/N Accommodation by prior arrangement only Can you swim: Y/N Have you ever done a Capsize Drill: Y/N Medical conditions (please list relevant history) ........................................................................................................................................... .......................................................................................................................................... ......................................................................................................................................... Special dietary requirements .......................................................................................................................................... .......................................................................................................................................... .......................................................................................................................................... Emergency Contact 1 Emergency Contact 1 Name Parent/Guardian Name Parent/Guardian ............................................................... ............................................................... Address: Address: ............................................................... ............................................................... ................................................................ ............................................................... ................................................................ ............................................................... Telephone............................................... Telephone............................................... Mobile.................................................... Mobile.................................................... Email...................................................... Email...................................................... Rowing Achievements: (Please list and state with which club/school/university they were achieved) What are your long term aims in rowing?: How did you hear about Leander Club?: (Please circle appropriate answer) 1. Rowing magazine article 2. Speaking to an Leander athlete/coach 3. Receiving a Leander Flyer 4. Visiting Leander Club website 5. By seeing results at 1. GB Trials 2. 4’s or 8’s head 3. Henley Royal Regatta 6. Presentation at Junior GB trials 7. Other (please state): ......................................................................................... Please e-mail this form to [email protected] or post to Chief Coach, Leander Club, Henley-on-Thames RG9 2LP .