2015/16 Far West Academy Rugby League Program Application

*Please print clearly and ensure all required information is entered including postcode and Medicare No. *Lightning Ridge residents please ensure your postal address is correct as mail will be returned by Post Office if street address is used ENROLMENT INFORMATION

Date of Birth Age in 2016 Are you of Aboriginal Torres Strait Islander descent? YES / NO / / Are you of a culturally diverse background? YES / NO

Name of School and Year Name of Club and Age Group

MEDICAL CONDITIONS

Please list any current medical conditions (i.e. asthma, allergies) or special dietary requirements

RUGBY LEAGUE DETAILS

Playing Positions 1 2 3

League History (Last Two Years)

Representative History

PRIVACY STATEMENT Country Rugby League and the FWAS will collect and store the information you provide to enable processing of enrolments for the program. The information will be provided to instructors of the program and their supervisors, where necessary, and you consent to this disclosure. If you have been asked for information regarding Aboriginal and Torres Strait Islander descent and cultural background, this information is voluntary and is being compiled for statistical purposes only. Any information provided by you will be stored on a database that will only be accessed by authorised personnel and is subject to privacy restrictions. The information will only be used for the purpose for which it was collected. Any information provided by you to Country Rugby League or the Far West Academy of Sport can be accessed by you during standard office hours and updated by writing to us or by contacting us on (02) 6885 0265 or (02) 6847 3638. RISK WAIVER AND MEDIA CONSENT I agree for my child/ward to attend the Centre to undertake all activities and/or to participate in the above program. In the case of an emergency, I authorise Country Rugby League or Far West Academy of Sport staff, where it is impracticable to communicate with me, to arrange for my child/ward, to receive such medical or surgical treatment as may be deemed necessary. I also undertake to pay or reimburse costs which may be incurred for medical attention, ambulance transport and drugs while my child/ward is attending the Centre/enrolled in the program.

I understand that although Country Rugby League and NSW Government and its service providers attempt to minimise any risk of personal injury within practical boundaries, accidents do happen and all physical activities carry the risk of personal injury. I acknowledge that there is an inherent risk of personal injury in physical activities that will be undertaken at the Centre/as part of the program and I accept that risk. b) Please circle whichever applies to you I consent / I do not consent to allow Country Rugby League and/or Far West Academy of Sport Inc. to use my child’s/my ward’s name and any photographs, sound and film recordings taken of my child/my ward at this program for the promotion of Country Rugby League and the Far West Academy of Sport Inc. services and initiative to the media and to the general public.

Parent/Guardian Name (must be over 18) Parent/Guardian Signature Date / /

All players trialing must be registered with a CRL club in 2015. Players are covered by their club insurance for the trial and academy sessions

Please return to the FWAS by Monday 19th October 2015 PO Box 409 Warren NSW 2824 Fax: (02) 6847 3651

2015/16 FWAS Rugby League Program Information

Country Championships have been revamped as a progression towards building development pathways for players based in regional areas. As part of the restructure, the Western Rams preparation and selection for the 16s and 18s Country Championships will be integrated into both the Western and Far West academy programs.

The Objectives of the Far West Academy program are:  to identify talented rugby league players in Far West NSW  to provide access to skill development and personnel development through a balanced High Performance Rugby League Program  Prepare players for the 2016 Country Championships  to provide a pathway & increase opportunities to achieve higher representative honors and progress to higher levels in Rugby League

Player Eligibility  Players turning 15 to 18 years of age in 2016 (ie born in 1998, 1999, 2000, 2001)  Players must reside in the Far West Region as determined by the following pre-selected boundaries: o Nyngan, Cobar, Narromine (Group XI) o Trangie, Warren, , Gilgandra, Baradine, Coolah, Binnaway, and (Castlereagh Cup/Group 14) o Bourke, Brewarrina, Goodooga, Lightning Ridge, Walgett, Collarenebri (Barwon Darling) o Lake Cargelligo, Broken Hill, Wilcannia, Menindee, Un-incorporated NSW (Outback)  Players must be a member of an affiliated club or are prepared to become one

Cost: The fee for players in the Far West Academy Program is $200, the fee subsidizes all costs associated with the satellite sessions, training camps and matches as well as any training and playing apparel that athletes receive during the program.

This fee MUST BE PAID prior to the 2nd Satellite Centre and should be paid directly to the Far West Academy of Sport Office. Payment methods include cash, cheque or direct deposit. (Cheques are to be made payable to the Far West Academy of Sport). If payment presents a problem please contact the FWAS so that suitable arrangements can be made to assist you.

If you have any questions or require further information please don’t hesitate to contact the Far West Academy of Sport staff or NRL Western Regional Manager Kyle Myers.

Far West Academy Staff Contact Details Jarrad Linton Harland NRL Regional Manager – Western Programs & Development Officer Kyle Myers [email protected] [email protected] (02) 6847 3638 or 0427 658 828 (02) 6885 0265 or 0400 367 558

DRAFT SCHEDULE FAR WEST ACADEMY AND WESTERN RAMS

Satellite Sessions 1-3: Check below table for your centre details and confirm sessions 2 & 3 with local Satellite coach following first session. Satellite Location Towns in Catchment Satellite Dates Time

Coolah Coolah, Dunedoo, Tuesday 6th, 13th & 27th October 5pm – 7pm Coonabarabran, Gulgong, Binnaway th th st Gilgandra Gilgandra, Narromine, Sunday 11 , 18 October & 1 10am – 12pm Coonamble, Warren, November Gulargambone, Baradine Nyngan Nyngan, Cobar Saturday 10th, 17th & 31st October 10m – 12pm

Collarenebri Collarenebri, Lightning Ridge, Wednesday 7th, 13th & 27th October 5pm – 7pm Walgett, Goodooga Bourke Bourke, Brewarrina Tuesday 6th, 13th & 27th October 5pm – 7pm

Broken Hill Broken Hill, Menindee, Saturday 10th, 17th & 31st October 10am – 12pm Wilcannia

Saturday 7th & Sunday 8th November 2015 – Warren: Far West Academy Selection Camp (15, 16, 17 & 18yr old that are identified as talented and have shown commitment to the program from Satellite Sessions 1-3 will be invited to attend this camp) Far West Academy U16’s & U18’s Train On Squads will be announced at the conclusion of this camp.

Sunday 15th November 2015 – Dubbo: Western Academy/Far West Academy train on squad’s induction, testing, and all players to assemble at Caltex Park Dubbo at 9:45AM. The session will finish at 3:00PM.

Satellite Session 4: Dates TBC and announced by coaches at the Training Camp in Warren on 7th & 8th November

Saturday January 17 2016 – Far West Academy U16’s & U18’s Train On Squads training session. Time and venue to be advised.

February 6, 2016, Saturday – at Mudgee: Trial games against the Newcastle Knights squads and Far West Academy at Glen Willow Sporting Complex Mudgee. Arrival times to be advised.

Monday February 22, 2016 – Western Rams under 16s and under 18s squads finalised (DATE subject to change).

POTENTIAL COMMITMENTS for players turning 16, 17 or 18 years in 2016.

FINAL WESTERN RAMS 16s and 18s SQUAD FURTHER TRAINING: March 2, March 9, March 16, March 23, March 30, April 6, April 13, April 20

16s and 18s CRL CHAMPIONSHIP GAMES

April 2, April 9, April 16: Rounds 1, 2 and 3 Country Championships

April 23: Semi Finals Country Championships April 30: Final Country Championships