Thank You for Downloading the Nomination Pack for the 2009 World University Winter Games

Thank you for downloading the nomination pack for the 2009 World University Winter Games. Enclosed within this pack you will find all of the required documents for your nomination for selection for the 2009 Games.

Please ensure that you read all of the information carefully and complete ALL of the required paperwork CORRECTLY. If you have any queries about the paperwork please contact the BUCS office on 020 7633 5080. We have included a check list to help you to ensure that you return all of the relevant documents to the BUCS office. If paperwork is returned to the Office incomplete you will be informed by email what information is missing and asked to complete it as soon as possible. If all of your paperwork has been completed correctly you will receive an email from us confirming receipt of the information.

PLEASE NOTE YOU WILL NOT BE CONSIDERED FOR SELECTION UNTIL ALL OF THE REQUIRED PAPERWORK HAS BEEN CORRECTLY COMPLETED AND RETURNED TO THE BUCS OFFICE.

The majority of future correspondence with you will be via email, therefore please ensure that you give us your correct email address being careful about whether it is a .com or .co.uk address

Further details pertaining to the Games can be found at and you should check this website for regular updates and further specific information for the travelling delegationor the organising committee’s website

Jo Kirk

Head of Development and International Programmes

Please complete and return ALL of the paperwork listed belowand tick the relevant boxes to confirm that the paperwork is included within the envelope.

Nomination Form
Please note this MUST be signed by AU President / Sport Officer /
Copy of back page of passport
If selected your passport will be required at a later date for visa purposes /
Certificate of Academic Eligibility / Graduation Certificate
CURRENT STUDENTS - Section 2 needs to be completed by a senior member of the university’s Registry Office or equivalent and NOT a member of the Athletic Union / Students Union or Sports Department. The institution stamp that is required should be the full and formal university stamp and not a students’ union / athletic union stamp. The university must also sign the reverse of the form to confirm that you meet the eligibility criteria.
ONE YEAR DOWN STUDENTS
If you are a ‘One Year Down’ student (i.e. you graduated in 2008) please send a photocopy of your Graduation Certificate to the BUCS Office. You do not need to complete a Certificate of Academic Eligibility. /
Passport Photos x4
Please write your name on the back of ALLphotos (these must have a white background) /
Medical Form
Please include a copy your aTUE/TUE if applicable /
TUE (if applicable) /
Physiotherapy Form & Injuryzone Consent Form /
Press Form /
Chinese Visa Application /

I confirm that I have sent all of the above paperwork to the BUCS Office, 20 – 24 King’s Bench Street, London, SE1 0QX

Upon selection I acknowledge that I will be required to pay a personal contribution of £580 and sign a Team Members Agreement

Name / Signature
Date

OFFICE USE ONLYDate ReceivedChecked

Input onto DatabaseRequested additional information

COMPETITOR NOMINATION FORM

Event / Sport:WORLD UNIVERSITY WINTER GAMES 2009–FIGURE SKATING

All fields are mandatory, complete in block capital letters and enclose a copy of the back page of your passport

PERSONAL DETAILS

Name as per passport:
Postal Address:
Post Code:
Email:
Mobile Number:
Home / Work Number:

PASSPORT DETAILS

Passport Number:
Expiry Date *
Date of Birth
Place of Birth

*you must have at least 6 months remaining on your passport to be able to travel

UNIVERSITY DETAILS

University:
Course:
Start Date:
Finish Date:

KIT SIZES

Leisurewear kit will be supplied by Nike

XS (34/36) / L (41/43)
S (36/38) / XL (44/46)
M (38/40) / Height
Shoe Size

DIETARY REQUIREMENTS

Vegetarian / Other
Signature:
Date:

ELIGIBILITY REQUIREMENTS

BUCS currently applies the following regulations when selecting representative teams to participate in FISU competitions:

a)FISU Regulations 5.2.1

Only the following may participate as competitors in a FISU Sporting Event:

i)Students who are currently officially registered as proceeding towards a degree or diploma at the university or similar institute whose status is recognised by the appropriate national academic authority of their country (e.g. the Department of Education in the UK).

ii)Former students of the institutions mentioned in (i) who have obtained their academic degree/diploma in the year preceding the event.

b)FISU Regulations 5.2.3

All competitors must satisfy the following conditions.

i)be a national of the country they represent (therefore hold a full 10 year UK passport)

ii)be at least 17 and less than 28 years of age on January 1st in the year of the event (born between 1 January 1981 and 31 December 1991)

c)Students studying abroad are eligible for selection provided they satisfy FISU regulations 5.2.1 and 5.2.3

d)Students attending courses franchised out from an institution [complying with FISU Regulations 5.2.1 (i)] are eligible for selection providing they also satisfy FISU Regulation 5.2.3.

WARNING

The information given overleaf must be accurate and to the best of the signatories knowledge at the date indicated below. Action will be taken against anyone falsifying information or wilfully misleading BUCS. Should any information change, please inform the Organising Secretary immediately. Please ensure that you have read and understood the Eligibility Requirements.

We certify that the above information is correct and have read the regulations regarding eligibility.

Signed:Signed:

(Athlete)(AU President / Sports Officer)

Name (print):Name:

Date: Date:

Certificate of Academic Eligibility

Event / Sport:WORLD UNIVERSITY WINTER GAMES 2009–FIGURE SKATING

1. To be completed by competitor (in block capital letters)

Name as per Passport
UK Passport Number & Name of Issuing Office:
Place of Birth: / Date of Birth:
Institution: / Name & Title Degree:
Humanities / Science / Physical Education / Other Studies (delete as appropriate):
Course Commenced (date): / Course Ends (date):

2. To be completed by Institution Official(please turn over and sign the eligibility regulations)

I certify to the best of my knowledge that the above Academic Record is correct

Signed: / Print Name:
Position in Institution: / Date:

Photograph of CompetitorOfficial Institution Stamp

(This must be the official stamp of the institution, not the Student / Athletic Union stamp)

ELIGIBILITY REQUIREMENTS

BUCS currently applies the following regulations when selecting representative teams to participate in FISU competitions:

a)FISU Regulations 5.2.1

Only the following may participate as competitors in a FISU Sporting Event:

i)Students who are currently officially registered as proceeding towards a degree or diploma at the university or similar institute whose status is recognised by the appropriate national academic authority of their country (e.g. the Department of Education in the UK).

ii)Former students of the institutions mentioned in (i) who have obtained their academic degree/diploma in the year preceding the event.

b)FISU Regulations 5.2.3

All competitors must satisfy the following conditions.

i)be a national of the country they represent (therefore hold a full 10 year UK passport)

ii)be at least 17 and less than 28 years of age on January 1st in the year of the event (born between 1 January 1981 and 31 December 1991)

c)Students studying abroad are eligible for selection provided they satisfy FISU regulations 5.2.1 and 5.2.3

d)Students attending courses franchised out from an institution [complying with FISU Regulations 5.2.1 (i)] are eligible for selection providing they also satisfy FISU Regulation 5.2.3.

WARNING

The information given overleaf must be accurate and to the best of the signatories knowledge at the date indicated below. Action will be taken against anyone falsifying information or wilfully misleading BUCS. Should any information change, please inform the Organising Secretary immediately. Please ensure that you have read and understood the Eligibility Requirements.

We certify that the above information is correct and have read the regulations regarding eligibility.

Signed:Signed:

(Athlete)(AU President / Sports Officer)

Name (print):Name:

Date: Date:

WorldUniversityWinter Games

Harbin 2009

Confidential Medical Questionnaire

PLEASE COMPLETE CLEARLY IN BLOCK CAPITAL LETTERS

SPORT
Name
Date of Birth
Address
E-mail
Contact Tel Number
GP / Doctors Name, Address & Telephone number. Hospital Number if under hospital care.
NGB Doctor’s name/ e-mail address & contact number
Two Next of Kin Contact Details: Address and Telephone Number
1. Name:
Address:
Tel: / 2. Name
Address:
Tel:

Please List / Describe all serious old, chronic or existing injuries

1)
2)
3)
4)
5)
Please describe all serious illness or chronic medical conditions e.g. asthma, diabetes, high blood pressure, migraines, epilepsy. Also please list all previous operations e.g. appendix etc.
1)
2)
3)
4)
Allergies or Sensitivities

Blood Group. If you are able to trace your blood group this is extremely important information.

YES / NO / Details
Have you had a Dentist Appointment in the last year? (if no please arrange a dental check)
List recent acute illnesses in the last year. / YES / NO / Dates
Sore throat / cough / cold
Ear infection
Other infections or explained fever
Headaches
Diarrhoea and /or vomiting
Abdominal pain

Travel Abroad

/ YES / NO / Date/Details

Foreign trips this year

Problems with jet lag?

Travel sickness

Insomnia

Immunisations / YES / NO / Dates

Tetanus

Polio

Diptheria

Hep A

Hep B

MMR

Typhoid

YES / NO / Details

Have you previously used any travel medication

Days missed from training in last year due to:

Illness

Injury

Travel

Have you any recent episodes of:

/ YES / NO / Details

Palpitations

Dizziness

Chest pain

Shortness of breath

Loss of Consciousness/Collapse

Intolerance of heat

Abnormal fatigue

Gynaecological or Pelvic Problems

Abnormal muscle pain, cramps, stiffness

Please List ALL regular or one-off Medications and any Supplements taken over the last 3 months

Name / Dose / Frequency / Reason for Taking / Last taken / Tested ?
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
Please list details of drug testing at home and abroad in the last 6 months and their results if known.
1)
2)
3)
4)
Current aTUE/ TUE(Therapeutic Use Exemption)certificates:
Substance / Dose / Method of administration / Date submitted / Expiry Date / Granted by
Eg salbutamol / 100mcg / Inhalation 2puffs as nec / 10/6/07 / 31.5.09 / UKSport

FAILURE TO DECLARE A BANNED SUBSTANCE EVEN IF TAKEN AS CORRECT TREATMENT CAN RESULT IN A POSITIVE DOPING TEST

Please enclose a copy of current aTUE/TUE if applicable

Please use this space to provide any additional information that you feel is relevant.

I hereby confirm that the information above is accurate and complete. I confirm that I am not taking any banned substances and I will not take any medication or supplements during the games without first consulting a member of the medical team. All information contained herein is confidential and will only be available to the medical team. I also agree in the case of emergency that information can be obtained from my doctor at home.

SignatureDate

Please complete and return by 31 December 2008 to:

Harriet Collins, c/o BUCS, 20 – 24 King’s Bench Street, London, SE1 0QX

If, after completing this form, you become ill or injured, please update your team manager and the Chief Medical Officer, Harriet Collins at or via the BUCS Office 0207 633 5080

WorldUniversityWinter Games

Harbin 2009

Confidential Physiotherapy Questionnaire

PLEASE COMPLETE CLEARLY IN BLOCK CAPITAL LETTERS

SPORT
EVENT
Name:
Address:
Telephone number - / Daytime: / Evening:
E-mail address
Date of birth:
Event:
YES / NO
Have you suffered from any injuries during the past six months?
If yes, did you attend a physiotherapist, doctor or hospital for treatment?
Please give a written description of the injury (including the location and type of injury) and any treatment received
YES / NO
Are you still under the care of a physiotherapist, doctor or hospital?
If yes, what treatment are you currently receiving?
Please describe your current symptoms.
YES / NO
Do your current symptoms restrict your sporting activity?
Do you have any other ongoing injuries that you have not already mentioned?
If yes can you describe them, including how long they have been present and the treatment you are receiving for them.
If you are currently attending for physiotherapy treatment, please ask your physiotherapist to provide a brief report of your condition and treatment and return it with this form. Please provide their contact details below:
Name
Email Address
Tel No

Injury Zone

This is a web based, secure, system of recording medical and physiotherapy records. Funded athletes in the UK usually have their notes recorded on injury zone. During the World University Games we would like to record all medical records using this system. Please indicate below if your medical and physio notes are already stored on injury zone.

YES / NO

If not, please read the injury zone information sheet below after which we hope you will agree to have your notes recorded using the system.

Signed:Date:

InjuryZone - Guidance Note for Athletes

This note accompanies and should be read in conjunction with the Athlete Consent.

As you may know, UK Sport manages a centralised electronic medical records system (theSystem) on which it records and stores medical and certain demographic information (which is necessary to support the System) in relation to World Class Performance athletes and other elite UK athletes, specifically injury and illness histories and treatments.

The System has been implemented and subsequently improved as a result of a lengthyconsultancy process with senior medical staff from NGBs and the Home Country Institutes as a result of which the benefits of a centralised electronic medical records system were clearly identified and advocated.

What is the purpose of the System?

The core purpose of the System is to enable authorised Institute, NGB and other medical staff to provide more effective clinical management to elite athletes and to enhance the communicationbetween sports medicine practitioners working across the UK and abroad.

The System is a web-based tool facilitating enhanced communication between relevant authorisedNGB, Institute and athletes’ personal sports medicine practitioners (including doctors and physiotherapists) to enable them to access up-to-date medical information regarding elite athletes.

The System may also be used to enable medical practitioners to provide Institute and NGBperformance staff with general guidance as to the current training ability of a given athlete. You have the right to request that practitioners do not share this information at any time.

Data may be anonymised and used for research/study/audit purposes to enhance the quality ofcare received by athletes. The anonymisation will be such that no athlete can be identified from the data used.

What information is stored on the System?

In addition to medical information, the System contains certain demographic information (such ascontact addresses, phone numbers and date of birth) next of kin and disability classification information.

Who inputs and accesses information on the System?

The rights of access to the System will be strictly limited and controlled by UK Sport.

Authorised NGB, Institute and other authorised medical practitioners treating any given athlete areall authorised to input information on the System regarding that athlete. Indeed it is important that this happens so that the full benefits of the System can be derived. Practitioners using the system may include doctors, physiotherapists, sports masseurs, clinical nutritionists, nurses and medicaladministrators.

Only medical staff authorised by UK Sport are able to access the System. This will include BOA /BPA medical practitioners treating relevant athletes during Olympic or Paralympic Games or training at BOA / BPA camps and other medical team staff at major competitions.

Additionally a small number of UK Sport Helpdesk personnel have access rights to enable them tomanage and maintain the System.

Performance Directors and Coaches do not have access to the medical information stored in the

System.

The UK Sport “InjuryZone” Administrator will set up and provide training on the System forauthorised users and provide helpline assistance regarding the System.

Who is the UK Sport Administrator?

Naomi Siddall

UK Sport

40 Bernard Street

London

WC1N 1ST

Tel: 020 7211 5149

Is the System secure?

Yes. The System is web-based using secure encrypted communications (using HTTPS) over theInternet and user authentication is required for all access. All data is stored within a secure hosting centre with access carefully monitored and supervised. Athletes should therefore be re-assured that their medical data is stored in a highly secure and restricted environment.

Can athletes access information about themselves?

Yes. Athletes have the right to access information about themselves stored on the System.

Athletes should contact their team doctor in the first instance. The team doctor will be able toprovide advice about the steps required to either view or obtain a copy of your record.Alternatively, athletes may contact the System Administrator to request access to their record and further details will be provided upon request.

What happens if an athlete goes to a medical practitioner who does not have access to the System?

The athlete should obtain a copy of the notes that are made and ensure that these are passed onto

his / her medical team for loading onto the System.

Consent

Due to the sensitive nature of the information stored on the System, UK Sport is required to obtainyour consent to the processing of your medical information.