2020 Australian Judo Championships - Queensland Athlete Information & Nomination Pack
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2020
Australian Judo
Championships
Friday the 5th June to Monday 08th June 2020
Gold Coast Leisure Centre
Queensland
Athlete Information &
Nomination Pack
Page 1 of 16
PublicDear Athlete
Listed below is all the information you require as a member of the 2020 Queensland Judo Team
competing at the Australian Judo National Championships. The championships will be held at
the Gold Coast Sports and Leisure Centre, Nerang/Broadbeach Road, Gold Coast. Qld. (next to
Gold Coast Suns AFL Ground)
Athletes, Coaches and Officials for Judo QLD are required to wear Australian Judo
Championships photo accreditation at all times.
All players must be current financial members of Judo QLD. Documentation must be completed
and submitted by the due date. To register as a member of Judo QLD go to
www.judoqueensland.org.au then ‘Become a member’ on the home page.
Contents
Key Dates......................................................................................................3
State Team Committe ..................................................................................3-4
Competition Schedule & Back Patches. .......................................................4
Ordering Online Uniforms & Nomination Fees and Costs ...........................4
Weight Divisions ...........................................................................................5-7
Team Selection Criteria and State Squad Training .......................................7-8
Checklist .......................................................................................................9
Appendix A – Athlete Nomination ...............................................................10
Appendix B – Medical Profile and Phot ID ...................................................11-11
Appendix C – Athlete Agreement.................................................................13-13
Appendix D - Travel ......................................................................................15
Appendix E - Back Patch Order Form…………………………………………………….… 16
Page 2 of 16
PublicKEY DATES
26th Feb Qld Athlete Information & Nomination Forms Issued
23rd March Return Date of All Qld Team Nominations
19th April Final Qld Team Selection and Full Payment of Fees
27th April Final Online Qld Tracksuit / Apparel Order Date
27th April Final Back Patch order purchase date see page (16)
05-08th June National Judo Championships, Gold Coast Sports & Leisure Centre
HP and Senior Development Coach and Manager
Srdjan Andjelkovic 0413 673 927 judo.srdjan@gmail.com
HP and Junior Development Coach and Manager
Carl Conran 0412 672 514 carlconran@gmail.com
The 2020 Qld Management Team: -
SEQ Team Manager Scott Bannister 0418 262 521 banista@bigpond.com
SEQ Assistant Manager John Taylor 0431 302 270 john.e.taylor@optusnet.com.au
SEQ Assistant Manager Anna Rasmussen 0417 906 223 club.support@judoqueensland.org.au
NQ Team Manager Xavier Barker 0433 994 182 xbarker@hotmail.com
NQ Assistant Manager Robert Macintosh 0416 298 477 robmcintosh9@gmail.com
The 2020 Qld Coaching Team: -
SEQ Junior Head Coach Toshi Nakamura 0449 623 224 toshi.nakamura.628@icloud.com
SEQ Senior Head Coach Scott Steer 0411 798 123 judokasteer@yahoo.com.au
NQ Senior Head Coach Andreas Schmidt 0413 513 615 andyschmidt227@gmail.com
NQ Junior Head Coach Paul De Brincat 0410 331 545 pkdebrincat@bigpond.com
Assistant Coaches
NQ Senior Assistant Coach Xavier Barker 0433 994 182 Xbarker@hotmail.com
NQ Senior Assistant Coach Sebastian Temesi 0401 616 773 sebimester@hotmail.com
NQ Junior Assistant Coach Jeff Anderson 0427 586 413 jeffreyanderson8@bigpond.com
SEQ Senior Assistant Coach Sebastian Murphy 0428 723 726 sebmurphy15@gmail.com
SEQ Junior Assistant Coach Emily Conran 0447 538 537 emilyconran1@gmail.com
SEQ Junior Assistant Coach Tabitha Croton 0403 042 380 tabcroton@hotmail.com
SEQ Senior Assistant Coach Anna Rasmussen 0417 906 223 club.support@judoqueensland.org.au
Page 3 of 16
PublicKyu Grades Coaches
SEQ Kyu Grades Coach Sebastian Murphy 0428 723 726 sebmurphy15@gmail.com
NQ Kyu Grades Coach Mo Cook 0499 976 067 moluamccook@gmail.com
NQ Kyu Grades Coach Ari Hoogland 0439 594 291 ari.hoogland@gmail.com
SEQ No Limit’s Coaches
SEQ No Limits Coach Megumi Hamashima 0448 744 974 megumiham0609@gmail.com
NQ No Limits Coach Xavier Barker 0433 994 182 Xbarker@hotmail.com
Qld Veterans and Kata Coach
Srdjan Andjelkovic 0413 673 927 judo.srdjan@gmail.com
Key Information
Postal Address: Australian National Judo Championships
Judo Qld, Sports House,
150 Caxton Street, MILTON QLD 4064
Or please email PDF and photo to, banista@bigpond.com
JQ Banking Details: Name: Judo Federation of Australia (Qld) Inc.
Bank: Suncorp
BSB: 484 799
Account: 502009706
Reference: Players Surname + First Name Initial
Competition Schedule – Click 2020 National Championships Schedule or go to
www.judoqueensland.org.au click on news item Australian Nationals Schedule PDF.
Attaching Your Back Patch
• 3cm below bottom of collar
• Sew using strong white nylon thread
• Sew all 4 sides then an X linking corners
• Sew two parallel lines dividing patch into thirds
Note: Stitches are marked in red for clarity only!
The belt should not cover the back patch, smaller judogis
may require adjusting patch or using the 3cm space to fit.
Back Patches are $15.00 each. To order Back Patches, please complete order form in this document and
return orders to club.support@judoqueensland.org.au
Please ensure team selection approved before ordering back patches.
Page 4 of 16
PublicORDER ONLINE WITH DELIVERY TO YOUR DOOR!
Important Uniform information for, Competing Judoka, Managers and Coaches, the 2020
Queensland State Team Uniform and Support apparel remains the same as 2019 uniform.
Team Management will ‘NOT’ order apparel for you. You must order your Qld apparel on-
line. The cut-off date for uniform orders is 27th April 2020.
It is a requirement that all Athletes wear, at a minimum the current approved Polo T-shirt.
Please click below to order the Qld Team apparel.
https://www.kukrisports.com.au/teamshop/judoqueenslandbrisbanetsbshop/productNavListNg.action
Competitor Nomination Fee, plus $50.00 Administration
$60.00 per
Nomination for one division is $60.00, all additional divisions are nominated Please include
$60 each. note: Open divisions are additional nominations (i.e. A Back Patches
category, plus Please include
player nominating for a Cadet Division, Junior Men + Open = $60.00 + eg 2 Back Patches
$60 + $60) =$180.00 +$50.00 Administration + $30 for 2 Back Patches = $50.00 $50.00
Administration 2 x $15.00 = $30.00
$260.00 Administration
Judo QLD see order form
fee Total attached how to
$110.00 for purchase and pay
one entry
Please email a copy of your bank transfer payment receipt to club.support@judoqueensland.org.au application to
avoid embarrassing reminders! Your nomination will not be processed without confirmation of fees paid.
2020 Age and Weight Divisions
SENIOR MEN – 15 years + in 2020) minimum grade of 3rd Kyu (green) SENIOR GIRLS – 12, 13 or 14 in 2020 minimum grade of 4th Kyu (Full Orange)
Over 100 kg Over 63 kg
Over 90 kg and up to and including 100 kg Over 57 kg and up to and including 63 kg
Over 81 kg and up to and including 90 kg Over 52 kg and up to and including 57 kg
Over 73 kg and up to and including 81 kg Over 48 kg and up to and including 52 kg
Over 66 kg and up to and including 73 kg Over 44 kg and up to and including 48 kg
Over 60 kg and up to and including 66 kg Over 40 kg and up to and including 44 kg
Up to and including 60 kg Over 36 kg and up to and including 40 kg
Open, with no weight restriction. Up to and including 36 kg (possible new u/32kg division)
SENIOR WOMEN – 15years + in 2020 minimum grade of 3rd Kyu (green) JUNIOR BOYS – 9, 10 or 11 in 2020 minimum grade of 4th-Kyu (Full Orange)
Over 78 kg Over 50 kg
Over 70 kg and up to and including 78 kg Over 46 kg and up to and including 50 kg
Over 63 kg and up to and including 70 kg Over 42 kg and up to and including 46 kg
Over 57 kg and up to and including 63 kg Over 38 kg and up to and including 42 kg
Over 52 kg and up to and including 57 kg Over 34 kg and up to and including 38 kg
Over 48 kg and up to and including 52 kg Over 30 kg and up to and including 34 kg
Up to and including 48 kg Over 27 kg and up to and including 30 kg
Open, with no weight restriction. Up to and including 27 kg
Page 5 of 16
PublicJUNIOR MEN – 15 to 20 years in 2020 minimum grade of 3rd Kyu (green) JUNIOR GIRLS – 9, 10 or 11 in 2020 minimum grade of 4th-Kyu (Full Orange)
Over 100 kg Over 52 kg
Over 90 kg and up to and including 100 kg Over 48 kg and up to and including 52 kg
Over 81 kg and up to and including 90 kg Over 44 kg and up to and including 48 kg
Over 73 kg and up to and including 81 kg Over 40 kg and up to and including 44 kg
Over 66 kg and up to and including 73 kg Over 36 kg and up to and including 40 kg
Over 60 kg and up to and including 66 kg Over 32 kg and up to and including 36 kg
Over 55kg and up to and including 60 kg Over 29 kg and up to and including 32 kg
Up to and including 29 kg
JUNIOR WOMEN – 15 to 20 years in 2020 minimum grade of 3rd Kyu (green) SENIOR WOMEN KYU GRADE – 15+ in 2020 minimum grade of 3rd Kyu (green)
Over 78 kg Over 78 kg
Over 70 kg and up to and including 78 kg Over 70 kg and up to and including 78 kg
Over 63 kg and up to and including 70 kg Over 63 kg and up to and including 70 kg
Over 57 kg and up to and including 63 kg Over 57 kg and up to and including 63 kg
Over 52 kg and up to and including 57 kg Over 52 kg and up to and including 57 kg
Over 48 kg and up to and including 52 kg Over 48 kg and up to and including 52 kg
Over 44kg and up to and including 48 kg Up to and including 48 kg
CADET MEN – 15, 16, 17 in 2020 minimum grade of 3rd Kyu (Full Green). SENIOR MEN KYU GRADE – 15+ in 2020 minimum grade of 3rd Kyu (green)
Over 90 kg Over 100 kg
Over 81 kg and up to and including 90 kg Over 90 kg and up to and including 100 kg
Over 73 kg and up to and including 81 kg Over 81 kg and up to and including 90 kg
Over 66 kg and up to and including 73 kg Over 73 kg and up to and including 81 kg
Over 60 kg and up to and including 66 kg Over 66 kg and up to and including 73 kg
Over 55 kg and up to and including 60 kg Over 60 kg and up to and including 66 kg
Over 50 kg and up to and including 55 kg Up to and including 60 kg
Up to and including 50 kg
CADET WOMEN – 15, 16, 17 in 2020 minimum grade of 3rd Kyu (Full Green). MASTERS MEN – 30+ in 2020 minimum grade of 3rd Kyu (green)
Over 70 kg Over 100 kg
Over 63 kg and up to and including 70 kg Over 90 kg and up to and including 100 kg
Over 57 kg and up to and including 63 kg Over 81 kg and up to and including 90 kg
Over 52 kg and up to and including 57 kg Over 73 kg and up to and including 81 kg
Over 48 kg and up to and including 52 kg Over 66 kg and up to and including 73 kg
Over 44 kg and up to and including 48 kg Over 60 kg and up to and including 66 kg
Over 40 kg and up to and including 44 kg Up to and including 60 kg
SENIOR BOYS – 12, 13 or 14 in 2020 minimum grade of 4th Kyu (Full Orange) MASTERS WOMEN – 30+ in 2020 minimum grade of 3rd Kyu (green)
Over 66 kg Over 78 kg
Over 60 kg and up to and including 66 kg Over 70 kg and up to and including 78 kg
Over 55 kg and up to and including 60 kg Over 63 kg and up to and including 70 kg
Over 50 kg and up to and including 55 kg Over 57 kg and up to and including 63 kg
Over 45 kg and up to and including 50 kg Over 52 kg and up to and including 57 kg
Over 40 kg and up to and including 45 kg Over 48 kg and up to and including 52 kg
Over 36 kg and up to and including 40 kg Up to and including 48 kg
Up to and including 36 kg (possible new u/32kg division)
Page 6 of 16
PublicTeam Selection Criteria and State Squad Training
Judo Queensland is responsible for entering its players in the Judo Australia national championships. The Judo
Queensland Board is the ultimate decision‐making body for JQ and under this policy it delegates its authority to select
the team to the Selectors.
The State Team Selectors are: SEQ Manager, NQ Manager, HPSD Coach and JD Coach SEQ and NQ Head Coaches.
The Selectors make selection decisions under advice of the SEQ and NQ Head coaches with reference to criteria
including the JQ performance tracking system.
The Selectors have the right to exercise discretion and judgment on any selection, and particularly where exceptions
to the selection policy or matters not fully covered by the selection policy are applicable in a particular case.
The full QLD STATE TEAM SELECTION POLICY can be downloaded from the JQ website www.judoqueensland.org.au
under Judo Resources.
Refer to the JQ web site calendar for dates, times and locations for NQ and SEQ squad training. There are
approximately 10 sessions available in each region prior to the 2020 nationals.
If an Athlete sustains an injury and cannot train a medical certificate is required, followed by a medical clearance
before the athlete will be allowed to re-commence training and compete.
All injuries sustained at training and competition must be reported via the Judo QLD injury report form found on the
JQ website under Judo Resources.
Late entry fees apply by Judo Australia to the Nationals after due dates and entry to the nationals will be at the
discretion of Judo Australia.
Performance results in the 2019 GCIO Gold Coast International Open and 2020 Qld State Championships and will be
included as selection competitions for Qld State Team selection and / or 3 local / regional competitions.
Only the Qld State Coaches and Management Team are allowed on the Tatami (mat) during state training run
sessions.
A physio or nominated medical officer will be attending all state sessions.
Judogi and QLD State Team Apparel
Athletes must wear the team Polo T-shirt at all times when attending the National Championships. Parents
and supporters are encouraged to wear the Queensland Polo T-shirt or maroon clothing. It is also preferred
that athletes wear the Polo T-shirt whilst travelling to and from the Championships. Athletes attending medal
presentations must wear full white judogi
Reminder to all female players that a plain white t-shirt must be worn under the judogi, this cannot be a
coloured T shirt, or have writing and must not be a singlet or crop top. No metal clips or bands in hair or on
body. Male players are not to wear any t-shirt under the judogi. Compression pants such as skins may be
worn under the judogi. The compression pants must be knee length and finish above the knee and not visible
under the judogi. Females may wear white coloured compression top with no part of the torso being exposed,
the sleeves must finish above the elbow and not visible under the judogi.
Blue and White Judogi is compulsory for all divisions from Junior Boys and Girls,
through to Master’s Players, excluding Kata Entries (White Only).
Page 7 of 16
PublicThe player called first will wear the white judogi. Mixed judogis are not allowed, the judogi
must be all white, or all blue. Queensland Back Patches should be correctly and securely
fixed to the judogi. All judogis must be compliant with size requirements.
Please check with a State Coach if you are unsure if your judogi is compliant.
Queensland Team Travel Arrangements and Accommodation
It is the responsibility of the individual player to organise their own personal travel arrangements to and from
Gold Coast. If you wish to stay on the Gold Coast, we suggest Broadbeach as the closest place to stay. It is
important to realise that this is a long weekend in Queensland, and the Gold Coast area will be busier than
usual. There is ample parking at the venue.
Player Registration Process
It is critical that every player clearly completes all documentation and holds a current identification card such
as student ID, driver’s licence or similar. Club Coaches must check and sign in the relevant areas. Documents
must be returned prior to the due date 23rd March 2020 to be eligible for selection under “QLD State Team
Selection Policy”. Full payment of fees is required by the due date, no late applications will be accepted.
There is a $50.00 administration fee to include, as per previous years. No deposit or part payments will be
taken.
Withdrawals and Refunds
No refunds will be given without a relevant medical certificate. If an athlete withdraws prior to 15th May 2020
a full reimbursement will be provided less a Judo Qld administration fee of $25. If the withdrawal is after 15th
May 2020 the player will be issued a reimbursement less $105 being $50 Judo Qld administration fee + $55
Judo Australia administration fee.
Page 8 of 16
PublicPlease complete ALL the following documents and return before 23rd March 2020
Checklist – Have you???
❑ EMAILED photograph to relevant regional manager
❑ Clearly completed Appendix A – Nomination Form
❑ Clearly completed Appendix B – Medical Profile
❑ Clearly completed Appendix C – Athletes Agreement and Waiver
❑ Clearly completed Appendix D – Travel Details
When completed email all documents to:
National Judo Championships, to your relevant regional Manager:
SEQ State Manager, Scott Bannister at banista@bigpond.com
NQ State Manager, Xavier Barker at, xbarker@hotmail.com
You must include a current JPEG photo of nominating Athlete.
Please reference Athletes surname and first name initial as payment I.D into the Judo Qld
Bank account.
Page 9 of 16
PublicAppendix A
NOMINATION FORM
2020 Queensland Team Player Nomination Form
(to be returned prior to 23rd March 2020)
Surname:
Given Names:
Address:
Date of Birth: Male / Female
Judo Club:
JQ Registration Number: Expiry Date:
Home Phone: Mobile Phone:
Email:
Cost Number Subtotal
Nomination Fee $60
Admin Fee $50 1 $50
Back Patch Each $15
Total Cost
Emergency Contact Name:
Relationship to you:
Emergency Contact Number:
Anticipated Weight Division: Grade/Kyu:
Select Division/s; Full payment is required to above mentioned bank account via, prepaid bank deposit. Nominated Age Division:
Junior Senior Cadet Men Senior Kyu Junior Senior Masters No
Boys Boys Men’s Men Men Men Limits
Junior Senior Cadet Senior Kyu Junior Senior Masters Kata
Girls Girls Women Women’s Women Women Women
Coach endorsement: I have checked the above information and believe it is true and correct.
Also please indicate which Judo competitions your Judoka has competed in prior to the 2020 Nationals.
❑ NSW, VIC, SA, ACT, QIO, International, Qld State Titles……...........................................................................................................
❑ 3 JFAQ Regional Competition’s …………………………………………………….……… ………………………………………………...
❑3 JFAQ Local Competition’s.……………………………………………………………………………………………………………………
Name of Coach: _________________________ Coach Signature: ________________________
Page 10 of 16
PublicAppendix B
MEDICAL PROFILE AND ID PHOTO (.JPG)
(to be returned prior to 23rd March 2020)
EMAIL A DIGTIAL .JPEG PHOTOGRAPH OF
ATHLETE TO YOUR REGIONAL MANAGER
For South QLD Nominations, banista@bigpond.com EMAIL A
For North QLD Nominations, xbarker@hotmail.com
*This is compulsory and must be included or nomination will not be
DIGITAL
accepted*
All information on this sheet is confidential. Access of this information is .JPG
limited to the Director Sports First Aid, State Coaches and State Managers
I hereby agree to the limited access of the following information and PHOTO
nominate the said athlete, knowing their health and ability, is satisfactory
to compete in the Queensland Judo Team to participate at the 2020
National Judo Championships.
Player Name:
Signature: if under 18 years Parent/Guardian to sign
Parent/Guardian Name if player is under 18 years:
Personal Details
Surname:
Given Names:
Address:
Postcode:
Home Phone:
Mobile:
Email:
Date of Birth: Sex: male / female
Health Care Details
Medicare Number:
Private Health Insurance: Yes / No if yes, Name of Fund:
Name of Doctor/GP:
Phone Number:
Name of Dentist:
Phone Number:
Page 11 of 16
PublicEmergency Contact Person
Name of Emergency Contact:
Relationship to you:
Phone Number:
Current Medical History
List current medical Details:
conditions including any
recent surgical procedures
(please attached additional
notes where necessary)
List regular medications Details:
including supplements,
including name and dosage
Do you have any Allergies? Yes / No if yes, please list type and severity
Do you wear glasses? Yes / No Do you wear contact lens? Yes / No
Do you suffer from recurring Yes / No if yes, please list type and severity
pain?
Do you suffer from back/neck Yes / No if yes, please list type and severity
pain?
Have you been treated for Yes / No if yes, please list type and severity
head, neck or spinal injury?
List any injury which is Details:
current, recurrent or requires
surgery.
Do you have any other Details:
medical conditions?
Do you consent to blood transfusion: Yes / No
Do any of these conditions affect your performance? Yes / No
Past History
Have you had or contracted any of the following?
Epilepsy Yes / No Hepatitis A Yes / No
Heart Problems Yes / No Hepatitis B Yes / No
Heart Murmur Yes / No Diabetes Yes / No
Asthma/Bronchitis Yes / No Concussion Yes / No
Hernia Yes / No Other: ______________________________________
Page 12 of 16
PublicAppendix C
ATHLETES AGREEMENT AND WAIVER
(to be returned prior to 23rd March 2020)
All players of the Queensland Judo Team are required to complete this Agreement. This form must
be completed by the parent/guardian if the athlete is under the age of 18 years.
Player Name:
Parent/Guardian Name if player is under 18 years:
2020 JFA National Championships (05-8thth June 2020)
Expectations of Queensland State Representatives
The inclusion in the State Judo Team is prestigious and very high profile, and this should be reflected by a high standard
of performance. Both in preparation for the event, and during the competition and in overall behaviour. Athletes are
representing QUEENSLAND with all the attendant expectations and responsibilities of JUDO QUEENSLAND’s Committee
of Management and its members. The athlete acknowledges these expectations.
Terms of Agreement
In consideration of Judo Queensland accepting the athlete as a member of the Judo Queensland State team for the
event and/or period shown, the athlete agrees as follows:
1. To comply with the requirements, including the terms and conditions for participation.
2. To exercise his/her best endeavours to render him/herself fit for competition.
3. To abide by the decision of the State Coaches and Managers whether to endorse inclusion into the State Team.
4. To disclose immediately to the State Coaches, Managers or other persons appointed by the JQ (Judo Queensland)
any injury, illness or other medical condition or recent surgery that might prejudice his/her taking part in the intended
competition or training leading up to the competition. Furthermore, any surgical procedures 2 months or prior to the
competition period will require a medical letter of clearance from the operating surgeon stating that the player is fit and
able to contest a National Martial Arts tournament. A letter of clearance from a General Practitioner will not be
acceptable and must be given by the OPERATING SURGEON.
5. To comply with all reasonable directions and instructions given by the State Coaches/Manager’s, or other persons
appointed by the JQ (Judo Queensland) during the required period.
6. To promptly meet all administrative requirements outlined and regarding the payment of any moneys relating to
participation as a Team member.
7. To advise State Coaches/Managers of any intention to engage in any activities outside the State Team activities.
8. To remain under the control, management and direction of the State Coaches/Managers, or other person appointed
by the Judo Queensland in all respects from the agreed date until his/her official release from the team. It is understood
that it is the responsibility of the individual or the parent/guardian of a person under 18 years in respect of duty of care
when not required to participate in team activities as directed by a State Team Official.
9. To conduct him/herself in a proper manner as a representative of the Judo Queensland at all times while a member of
the Team.
10. To wear clothing authorized by the State Coach/Manager or other person appointed by Judo Queensland
Page 13 of 16
Public11. To permit Judo Queensland to utilize any photograph or other image of the athlete as it sees fit and at its discretion for
the promotion of the sport of Judo.
12. Judo Queensland reserves the right to refuse, revoke or suspend membership of the Team without notice if they feel
it is in the best interest of the player due to health reasons or failure to comply with criteria requirements, Membership
of the Team may also be refused, revoked or suspended if a person has lied or intentionally misled Judo Queensland
in regards to their status. Furthermore, Judo Queensland reserves the right if at the time of the championships to
withdraw Team membership if a player fails to abide by rulings made by the Team Coach or Manager or reacts in a
manner unbecoming to the State Team.
I willingly enter, or give my permission for this participant to enter, the Judo Federation of Australia 2020 National
Championships (event) knowing that there are inherent risks of injury in participation. I agree that I will accept full liability
in the case of injury occurring. I have insurance for injury through membership of an IJF affiliated organisation or a separate
policy. I am aware that strangling and arm-lock techniques will be used in the cadet and above divisions and I warrant that
the participant has been adequately trained and coached in defence against these techniques, is fully fit to participate, and
is not carrying a pre-existing injury that is likely to be extended during this event. I further warrant that the participant is not
taking banned performance enhancing substances and will participate in good faith according to the JFA Inc code of
conduct. I accept that a participant's entry may be refused or terminated by Queensland State officials, or event officials
should they decide it appropriate for the safe and good conduct of the event or welfare of participants.
I acknowledge and accept the terms of this agreement as outlined in this Athlete's Agreement and Waiver.
Return Scanned completed PDF form including photo:
For South QLD Nominations, banista@bigpond.com
For North QLD Nominations, xbarker@hotmail.com
By not later than the 16th of March 2020.
Thank you.
Scott Bannister, South Queensland State Team Manager 2020
Xavier Barker, North Queensland State Team Manager 2020
Player Name: Date:
Signature: if under 18 years Parent/Guardian to sign
Parent/Guardian Name if player is under 18 years:
Parent/Guardian Signature: Date:
I confirm that the above-named athlete is fit, healthy and has adequately prepared to compete at
the Australian Judo Titles
Coach Name: Date:
Coach Signature:
Page 14 of 16
PublicAppendix D
YOUR TRAVEL TO THE NATIONALS
(to be returned prior to 23rd March 2020)
Player Name:
Contact Number:
Travelling by private car to the Gold Coast & venue: - Yes / No
No – Flying into Brisbane/Coolangatta Airport (North Qld Athletes)
Incoming Flight (arriving Brisbane/Gold Coast)
Airline: Flight No. Date: Time:
Outgoing Flight (departing Brisbane/Gold Coast)
Flight No. Date: Time:
Airline:
Accommodation:
Staying at the ............................................... Name/Address of accommodation:
Page 15 of 16
PublicAustralian Nationals 2020 Back Patch Order form
Name (Print or type clearly block letters please)
First Name __________________________
Last Name ___________________________
Judo Club ________________ Sensei _____________
Phone Number _____________ Quantity _________
e-mail address ________________________________
Back patches are $15.00 (each) $30.00 for 2
(add $5.00 for Postage to Nth Qld orders please).
Please fill in this form then scan and email your order to
club.support@judoqueensland.org.au, no later than Friday 27th April 2020
Deposit the money for the Back patches into the following account and use the (name of
the Judoka, last name and first initial) as reference for bank reconciliation and match up.
Judo Federation of Australia Queensland Pty Ltd (Suncorp bank)
BSB 484 799 - Account - 502009706
Back patches will be delivered to the 2nd to last Qld Squad State training or posted to you if
you live in North Qld with time to sew onto your judogis. (One Back Patch Required Per
judogi)
Page 16 of 16
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