Thank you for attending a VICTA Sport Young Achievers Award Day! Please complete the form below so that we can officially enter you into the Award scheme.

Name of VI Child *

Date of Birth *

Name of Parent/Carer *

Parent/Carer Contact Email Address *

Parent/Carer Contact Number *

Address line 1 *

Address line 2

City *

Postcode *

County *

Did you enjoy doing your tasks? (If 5 is you really enjoyed them and 1 is you didn't enjoy them) *

• 1
• 2
• 3
• 4
• 5

Would you recommend completing these tasks to a friend? *

• Yes
• No

Do you plan on continuing with the other sections? *

• Yes
• No

Do you have a brother or sister that’s been helping out with the award? *

• Yes
• No

Please tell us your super sibling's name for their certificate *

Your child's participation in sport

Please score your child 1 (lowest) – 5 (highest) on the following fundamental movement skills:

Running *

• 1
• 2
• 3
• 4
• 5

Walking *

• 1
• 2
• 3
• 4
• 5

Jumping *

• 1
• 2
• 3
• 4
• 5

Catching *

• 1
• 2
• 3
• 4
• 5

Throwing *

• 1
• 2
• 3
• 4
• 5

Kicking *

• 1
• 2
• 3
• 4
• 5

Balancing *

• 1
• 2
• 3
• 4
• 5

Bending *

• 1
• 2
• 3
• 4
• 5

Twisting *

• 1
• 2
• 3
• 4
• 5

Please Score your child 1 (lowest) – 5 (highest) on the following:

Confidence *

• 1
• 2
• 3
• 4
• 5

Independence *

• 1
• 2
• 3
• 4
• 5

Resilience *

• 1
• 2
• 3
• 4
• 5

Communication *

• 1
• 2
• 3
• 4
• 5

Interest in new things *

• 1
• 2
• 3
• 4
• 5

Anxiety in new situations *

• 1
• 2
• 3
• 4
• 5

Has your child expressed an interest in sport before? *

• Yes
• No

Is your child currently part of a sports club? *

• Yes
• No

Does your child currently take part in any regular sport or physical activity? *

• Yes
• No

Your preferences

Do you give permission for VICTA to use your photos/videos on our/their respective websites and social media channels? *

• Yes
• No

Are you happy to be contacted by VICTA for feedback on the Sport Young Achievers Award? *

• Yes
• No

Would you like to sign up to receive email updates from VICTA, VICTA Sport and the Student Portal? *

• Yes
• No
• I'm already signed up

Signed (Parent/Carer name) *

Submit