New Athletes Athlete Details Personal Information Athlete Name (required) House Name/Number Street Town/City District ---Amber ValleyBolsoverChesterfieldDerby CityDerbyshire DalesErewashHigh PeakNorth East DerbyshireSouth DerbyshireNot from Derbyshire Postcode Contact Details Phone Number Email Address Confirm Email Social Media Twitter handle Facebook Instagram Athlete Gender ---MaleFemalePrefer not to say Athlete Date of Birth Athlete Disability ---DisabledNon-disabledPrefer not to say If you have indicated that you have a disability, please choose as many of the following options that apply to you: ---Deaf/hearing impairmentVisual impairmentPhysical impairmentLearning disabilityLearning difficultyOther Name of your School, College or University (if applicable): Next Contacts Parent/ Guardian Details - (If athlete is under 18): Name Phone Number Email Address Coach Details Name Phone Number Email Address Sports Club Details Club Name PreviousNext Sport Information Sport Information Olympic Sport Please selectArcheryAthleticsBadmintonBoxinCanoeingCyclingEquestrianFencingGymnasticsJudoModern PentathlonRowingSailingShootingSwimmingTable TennisTaekwondoTriathlonWeightliftingWrestling Paralympic Sport Please selectBocciaDisability ShootingDisability Table TennisPara-ArcheryPara-AthleticsPara-CanoeingPara-CyclingPara-EquestrianDressagePara-RowingPara-SailingPara-SwimmingPara-TriathlonPowerliftingVI JudoWheelchair FencingWheelchair Tennis Winter Sport Please selectFigure SkatingShort Track Speed SkatingSkeletonSki and SnowboardPara Ski and Snowboard Please state which category/discipline(s) you compete in : PreviousNext Performances During 2016/2017 Last season, were you selected by a National Governing Body of Sport onto their World Class Programme? ---YesNo If yes, please provide details of how you were selected, what programme you have been selected onto and a link to a website which confirms your selection: Last season, were you selected by a National Governing Body of Sport to compete for GB or home country in a major international competition? ---YesNo If yes, please provide details of how you were selected, the date of the competition, your results and any website which confirms these details: Last season, did you win a national championship medal? ---YesNo If yes, please provide details of how you were selected, the date of the competition, your results and any website which confirms these details: Do you have a current UK ranking within the top 15? ---YesNo If yes, please state which age category this is for and provide the details of a website that can verify this information: Please list the 3 main competitions that you competed in, state your result and provide website details that can be used to verify this information: PreviousNext Goals For 2017/2018 Which of the following performance targets are you aiming to achieve during 2017/2018 Win a national championship medal – when is this taking place and what medal are aiming to win? Be selected by the NGB to compete internationally – which international event are you aiming to receive selection for and when does it take place? Gain selection onto a World Class Potential squad – when does selection take place and please provide Goals for 2017/2018 the details of who will be able to verify your selection. Are you aiming to compete at the next Commonwealth Games, Winter Olympics or Summer Olympics? Please list the 3 main competitions that you are planning to compete in during 2017/2018 and state when they take place and your anticipated result. Please provide details of your long term sporting aspirations: Why do you want to be part of the DIS? PreviousNext Submit Please provide any other information you think may be relevant: Please provide contact details for someone from your sport's governing body who will be able to verify your application: Name Position Phone Number Email Address Please check that you have completed the application form as detailed as you can and ensure that all information is accurate and correct. Your application will be validated and assessed in July and you should expect to hear from us by mid-August.