VICTA Sport Young Achievers Award - Organisations & Groups

Name of Organisation *

Contact Email Address *

Name of VI Child *

Child's participation in sport

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

Child (1)'s participation in sport - Please score the named child from 1 (lowest) – 5 (highest) on the following fundamental movement skills: *

	1	2	3	4	5
Running	1Running 1	2Running 2	3Running 3	4Running 4	5Running 5
Walking	1Walking 1	2Walking 2	3Walking 3	4Walking 4	5Walking 5
Jumping	1Jumping 1	2Jumping 2	3Jumping 3	4Jumping 4	5Jumping 5
Catching	1Catching 1	2Catching 2	3Catching 3	4Catching 4	5Catching 5
Throwing	1Throwing 1	2Throwing 2	3Throwing 3	4Throwing 4	5Throwing 5
Kicking	1Kicking 1	2Kicking 2	3Kicking 3	4Kicking 4	5Kicking 5
Balancing	1Balancing 1	2Balancing 2	3Balancing 3	4Balancing 4	5Balancing 5
Bending	1Bending 1	2Bending 2	3Bending 3	4Bending 4	5Bending 5
Twisting	1Twisting 1	2Twisting 2	3Twisting 3	4Twisting 4	5Twisting 5

Please score the named child (1) from 1 (lowest) – 5 (highest) on the following: *

	1	2	3	4	5
Confidence	1Confidence 1	2Confidence 2	3Confidence 3	4Confidence 4	5Confidence 5
Independence	1Independence 1	2Independence 2	3Independence 3	4Independence 4	5Independence 5
Resilience	1Resilience 1	2Resilience 2	3Resilience 3	4Resilience 4	5Resilience 5
Communication	1Communication 1	2Communication 2	3Communication 3	4Communication 4	5Communication 5
Interest in new things	1Interest in new things 1	2Interest in new things 2	3Interest in new things 3	4Interest in new things 4	5Interest in new things 5
Anxiety in new situations	1Anxiety in new situations 1	2Anxiety in new situations 2	3Anxiety in new situations 3	4Anxiety in new situations 4	5Anxiety in new situations 5

Have they expressed an interest in sport before? *

Yes
No

Are they currently part of a sports club? *

Yes
No

Would you like to add another child to this application? *

Yes
No

Name of VI Child (2) *

Child (2)'s participation in sport - Please score the named child from 1 (lowest) – 5 (highest) on the following fundamental movement skills: *

	1	2	3	4	5
Running	1Running 1	2Running 2	3Running 3	4Running 4	5Running 5
Walking	1Walking 1	2Walking 2	3Walking 3	4Walking 4	5Walking 5
Jumping	1Jumping 1	2Jumping 2	3Jumping 3	4Jumping 4	5Jumping 5
Catching	1Catching 1	2Catching 2	3Catching 3	4Catching 4	5Catching 5
Throwing	1Throwing 1	2Throwing 2	3Throwing 3	4Throwing 4	5Throwing 5
Kicking	1Kicking 1	2Kicking 2	3Kicking 3	4Kicking 4	5Kicking 5
Balancing	1Balancing 1	2Balancing 2	3Balancing 3	4Balancing 4	5Balancing 5
Bending	1Bending 1	2Bending 2	3Bending 3	4Bending 4	5Bending 5
Twisting	1Twisting 1	2Twisting 2	3Twisting 3	4Twisting 4	5Twisting 5

Please score the named child (2) from 1 (lowest) – 5 (highest) on the following: *

	1	2	3	4	5
Confidence	1Confidence 1	2Confidence 2	3Confidence 3	4Confidence 4	5Confidence 5
Independence	1Independence 1	2Independence 2	3Independence 3	4Independence 4	5Independence 5
Resilience	1Resilience 1	2Resilience 2	3Resilience 3	4Resilience 4	5Resilience 5
Communication	1Communication 1	2Communication 2	3Communication 3	4Communication 4	5Communication 5
Interest in new things	1Interest in new things 1	2Interest in new things 2	3Interest in new things 3	4Interest in new things 4	5Interest in new things 5
Anxiety in new situations	1Anxiety in new situations 1	2Anxiety in new situations 2	3Anxiety in new situations 3	4Anxiety in new situations 4	5Anxiety in new situations 5

Have they (child 2) expressed an interest in sport before? *

Yes
No

Are they (child 2) currently part of a sports club? *

Yes
No

Would you like to add a third child to this application? *

Yes
No

Name of VI Child (3) *

Child (3)'s participation in sport - Please score the named child from 1 (lowest) – 5 (highest) on the following fundamental movement skills: *

	1	2	3	4	5
Running	1Running 1	2Running 2	3Running 3	4Running 4	5Running 5
Walking	1Walking 1	2Walking 2	3Walking 3	4Walking 4	5Walking 5
Jumping	1Jumping 1	2Jumping 2	3Jumping 3	4Jumping 4	5Jumping 5
Catching	1Catching 1	2Catching 2	3Catching 3	4Catching 4	5Catching 5
Throwing	1Throwing 1	2Throwing 2	3Throwing 3	4Throwing 4	5Throwing 5
Kicking	1Kicking 1	2Kicking 2	3Kicking 3	4Kicking 4	5Kicking 5
Balancing	1Balancing 1	2Balancing 2	3Balancing 3	4Balancing 4	5Balancing 5
Bending	1Bending 1	2Bending 2	3Bending 3	4Bending 4	5Bending 5
Twisting	1Twisting 1	2Twisting 2	3Twisting 3	4Twisting 4	5Twisting 5

Please score the named child (3) from 1 (lowest) – 5 (highest) on the following: *

	1	2	3	4	5
Confidence	1Confidence 1	2Confidence 2	3Confidence 3	4Confidence 4	5Confidence 5
Independence	1Independence 1	2Independence 2	3Independence 3	4Independence 4	5Independence 5
Resilience	1Resilience 1	2Resilience 2	3Resilience 3	4Resilience 4	5Resilience 5
Communication	1Communication 1	2Communication 2	3Communication 3	4Communication 4	5Communication 5
Interest in new things	1Interest in new things 1	2Interest in new things 2	3Interest in new things 3	4Interest in new things 4	5Interest in new things 5
Anxiety in new situations	1Anxiety in new situations 1	2Anxiety in new situations 2	3Anxiety in new situations 3	4Anxiety in new situations 4	5Anxiety in new situations 5

Have they (child 3) expressed an interest in sport before? *

Yes
No

Are they (child 3) currently part of a sports club? *

Yes
No

Would you like to add a fourth child to this application? *

Yes
No

Name of VI Child (4) *

Child (4)'s participation in sport - Please score the named child from 1 (lowest) – 5 (highest) on the following fundamental movement skills: *

	1	2	3	4	5
Running	1Running 1	2Running 2	3Running 3	4Running 4	5Running 5
Walking	1Walking 1	2Walking 2	3Walking 3	4Walking 4	5Walking 5
Jumping	1Jumping 1	2Jumping 2	3Jumping 3	4Jumping 4	5Jumping 5
Catching	1Catching 1	2Catching 2	3Catching 3	4Catching 4	5Catching 5
Throwing	1Throwing 1	2Throwing 2	3Throwing 3	4Throwing 4	5Throwing 5
Kicking	1Kicking 1	2Kicking 2	3Kicking 3	4Kicking 4	5Kicking 5
Balancing	1Balancing 1	2Balancing 2	3Balancing 3	4Balancing 4	5Balancing 5
Bending	1Bending 1	2Bending 2	3Bending 3	4Bending 4	5Bending 5
Twisting	1Twisting 1	2Twisting 2	3Twisting 3	4Twisting 4	5Twisting 5

Please score the named child (4) from 1 (lowest) – 5 (highest) on the following: *

	1	2	3	4	5
Confidence	1Confidence 1	2Confidence 2	3Confidence 3	4Confidence 4	5Confidence 5
Independence	1Independence 1	2Independence 2	3Independence 3	4Independence 4	5Independence 5
Resilience	1Resilience 1	2Resilience 2	3Resilience 3	4Resilience 4	5Resilience 5
Communication	1Communication 1	2Communication 2	3Communication 3	4Communication 4	5Communication 5
Interest in new things	1Interest in new things 1	2Interest in new things 2	3Interest in new things 3	4Interest in new things 4	5Interest in new things 5
Anxiety in new situations	1Anxiety in new situations 1	2Anxiety in new situations 2	3Anxiety in new situations 3	4Anxiety in new situations 4	5Anxiety in new situations 5

Have they (child 4) expressed an interest in sport before? *

Yes
No

Are they (child 4) currently part of a sports club? *

Yes
No

Would you like to add a fifth child to this application? *

Yes
No

Name of VI Child (5) *

Child (5)'s participation in sport - Please score the named child from 1 (lowest) – 5 (highest) on the following fundamental movement skills: *

	1	2	3	4	5
Running	1Running 1	2Running 2	3Running 3	4Running 4	5Running 5
Walking	1Walking 1	2Walking 2	3Walking 3	4Walking 4	5Walking 5
Jumping	1Jumping 1	2Jumping 2	3Jumping 3	4Jumping 4	5Jumping 5
Catching	1Catching 1	2Catching 2	3Catching 3	4Catching 4	5Catching 5
Throwing	1Throwing 1	2Throwing 2	3Throwing 3	4Throwing 4	5Throwing 5
Kicking	1Kicking 1	2Kicking 2	3Kicking 3	4Kicking 4	5Kicking 5
Balancing	1Balancing 1	2Balancing 2	3Balancing 3	4Balancing 4	5Balancing 5
Bending	1Bending 1	2Bending 2	3Bending 3	4Bending 4	5Bending 5
Twisting	1Twisting 1	2Twisting 2	3Twisting 3	4Twisting 4	5Twisting 5

Please score the named child (5) from 1 (lowest) – 5 (highest) on the following: *

	1	2	3	4	5
Confidence	1Confidence 1	2Confidence 2	3Confidence 3	4Confidence 4	5Confidence 5
Independence	1Independence 1	2Independence 2	3Independence 3	4Independence 4	5Independence 5
Resilience	1Resilience 1	2Resilience 2	3Resilience 3	4Resilience 4	5Resilience 5
Communication	1Communication 1	2Communication 2	3Communication 3	4Communication 4	5Communication 5
Interest in new things	1Interest in new things 1	2Interest in new things 2	3Interest in new things 3	4Interest in new things 4	5Interest in new things 5
Anxiety in new situations	1Anxiety in new situations 1	2Anxiety in new situations 2	3Anxiety in new situations 3	4Anxiety in new situations 4	5Anxiety in new situations 5

Have they (child 5) expressed an interest in sport before? *

Yes
No

Are they (child 5) currently part of a sports club? *

Yes
No

Would you like to add a sixth child to this application? *

Yes
No

Name of VI Child (6) *

Child (6)'s participation in sport - Please score the named child from 1 (lowest) – 5 (highest) on the following fundamental movement skills: *

	1	2	3	4	5
Running	1Running 1	2Running 2	3Running 3	4Running 4	5Running 5
Walking	1Walking 1	2Walking 2	3Walking 3	4Walking 4	5Walking 5
Jumping	1Jumping 1	2Jumping 2	3Jumping 3	4Jumping 4	5Jumping 5
Catching	1Catching 1	2Catching 2	3Catching 3	4Catching 4	5Catching 5
Throwing	1Throwing 1	2Throwing 2	3Throwing 3	4Throwing 4	5Throwing 5
Kicking	1Kicking 1	2Kicking 2	3Kicking 3	4Kicking 4	5Kicking 5
Balancing	1Balancing 1	2Balancing 2	3Balancing 3	4Balancing 4	5Balancing 5
Bending	1Bending 1	2Bending 2	3Bending 3	4Bending 4	5Bending 5
Twisting	1Twisting 1	2Twisting 2	3Twisting 3	4Twisting 4	5Twisting 5

Please score the named child (6) from 1 (lowest) – 5 (highest) on the following: *

	1	2	3	4	5
Confidence	1Confidence 1	2Confidence 2	3Confidence 3	4Confidence 4	5Confidence 5
Independence	1Independence 1	2Independence 2	3Independence 3	4Independence 4	5Independence 5
Resilience	1Resilience 1	2Resilience 2	3Resilience 3	4Resilience 4	5Resilience 5
Communication	1Communication 1	2Communication 2	3Communication 3	4Communication 4	5Communication 5
Interest in new things	1Interest in new things 1	2Interest in new things 2	3Interest in new things 3	4Interest in new things 4	5Interest in new things 5
Anxiety in new situations	1Anxiety in new situations 1	2Anxiety in new situations 2	3Anxiety in new situations 3	4Anxiety in new situations 4	5Anxiety in new situations 5

Have they (child 6) expressed an interest in sport before? *

Yes
No

Are they (child 6) currently part of a sports club? *

Yes
No

Would you like to add a seventh child to this application? *

Yes
No

Name of VI Child (7) *

Child (7)'s participation in sport - Please score the named child from 1 (lowest) – 5 (highest) on the following fundamental movement skills: *

	1	2	3	4	5
Running	1Running 1	2Running 2	3Running 3	4Running 4	5Running 5
Walking	1Walking 1	2Walking 2	3Walking 3	4Walking 4	5Walking 5
Jumping	1Jumping 1	2Jumping 2	3Jumping 3	4Jumping 4	5Jumping 5
Catching	1Catching 1	2Catching 2	3Catching 3	4Catching 4	5Catching 5
Throwing	1Throwing 1	2Throwing 2	3Throwing 3	4Throwing 4	5Throwing 5
Kicking	1Kicking 1	2Kicking 2	3Kicking 3	4Kicking 4	5Kicking 5
Balancing	1Balancing 1	2Balancing 2	3Balancing 3	4Balancing 4	5Balancing 5
Bending	1Bending 1	2Bending 2	3Bending 3	4Bending 4	5Bending 5
Twisting	1Twisting 1	2Twisting 2	3Twisting 3	4Twisting 4	5Twisting 5

Please score the named child (7) from 1 (lowest) – 5 (highest) on the following: *

	1	2	3	4	5
Confidence	1Confidence 1	2Confidence 2	3Confidence 3	4Confidence 4	5Confidence 5
Independence	1Independence 1	2Independence 2	3Independence 3	4Independence 4	5Independence 5
Resilience	1Resilience 1	2Resilience 2	3Resilience 3	4Resilience 4	5Resilience 5
Communication	1Communication 1	2Communication 2	3Communication 3	4Communication 4	5Communication 5
Interest in new things	1Interest in new things 1	2Interest in new things 2	3Interest in new things 3	4Interest in new things 4	5Interest in new things 5
Anxiety in new situations	1Anxiety in new situations 1	2Anxiety in new situations 2	3Anxiety in new situations 3	4Anxiety in new situations 4	5Anxiety in new situations 5

Have they (child 7) expressed an interest in sport before? *

Yes
No

Are they (child 7) currently part of a sports club? *

Yes
No

Would you like to add a eighth child to this application? *

Yes
No

Name of VI Child (8) *

Child (8)'s participation in sport - Please score the named child from 1 (lowest) – 5 (highest) on the following fundamental movement skills: *

	1	2	3	4	5
Running	1Running 1	2Running 2	3Running 3	4Running 4	5Running 5
Walking	1Walking 1	2Walking 2	3Walking 3	4Walking 4	5Walking 5
Jumping	1Jumping 1	2Jumping 2	3Jumping 3	4Jumping 4	5Jumping 5
Catching	1Catching 1	2Catching 2	3Catching 3	4Catching 4	5Catching 5
Throwing	1Throwing 1	2Throwing 2	3Throwing 3	4Throwing 4	5Throwing 5
Kicking	1Kicking 1	2Kicking 2	3Kicking 3	4Kicking 4	5Kicking 5
Balancing	1Balancing 1	2Balancing 2	3Balancing 3	4Balancing 4	5Balancing 5
Bending	1Bending 1	2Bending 2	3Bending 3	4Bending 4	5Bending 5
Twisting	1Twisting 1	2Twisting 2	3Twisting 3	4Twisting 4	5Twisting 5

Please score the named child (8) from 1 (lowest) – 5 (highest) on the following: *

	1	2	3	4	5
Confidence	1Confidence 1	2Confidence 2	3Confidence 3	4Confidence 4	5Confidence 5
Independence	1Independence 1	2Independence 2	3Independence 3	4Independence 4	5Independence 5
Resilience	1Resilience 1	2Resilience 2	3Resilience 3	4Resilience 4	5Resilience 5
Communication	1Communication 1	2Communication 2	3Communication 3	4Communication 4	5Communication 5
Interest in new things	1Interest in new things 1	2Interest in new things 2	3Interest in new things 3	4Interest in new things 4	5Interest in new things 5
Anxiety in new situations	1Anxiety in new situations 1	2Anxiety in new situations 2	3Anxiety in new situations 3	4Anxiety in new situations 4	5Anxiety in new situations 5

Have they (child 8) expressed an interest in sport before? *

Yes
No

Are they (child 8) currently part of a sports club? *

Yes
No

Would you like to add a ninth child to this application? *

Yes
No

Name of VI Child (9) *

Child (9)'s participation in sport - Please score the named child from 1 (lowest) – 5 (highest) on the following fundamental movement skills: *

	1	2	3	4	5
Running	1Running 1	2Running 2	3Running 3	4Running 4	5Running 5
Walking	1Walking 1	2Walking 2	3Walking 3	4Walking 4	5Walking 5
Jumping	1Jumping 1	2Jumping 2	3Jumping 3	4Jumping 4	5Jumping 5
Catching	1Catching 1	2Catching 2	3Catching 3	4Catching 4	5Catching 5
Throwing	1Throwing 1	2Throwing 2	3Throwing 3	4Throwing 4	5Throwing 5
Kicking	1Kicking 1	2Kicking 2	3Kicking 3	4Kicking 4	5Kicking 5
Balancing	1Balancing 1	2Balancing 2	3Balancing 3	4Balancing 4	5Balancing 5
Bending	1Bending 1	2Bending 2	3Bending 3	4Bending 4	5Bending 5
Twisting	1Twisting 1	2Twisting 2	3Twisting 3	4Twisting 4	5Twisting 5

Please score the named child (9) from 1 (lowest) – 5 (highest) on the following: *

	1	2	3	4	5
Confidence	1Confidence 1	2Confidence 2	3Confidence 3	4Confidence 4	5Confidence 5
Independence	1Independence 1	2Independence 2	3Independence 3	4Independence 4	5Independence 5
Resilience	1Resilience 1	2Resilience 2	3Resilience 3	4Resilience 4	5Resilience 5
Communication	1Communication 1	2Communication 2	3Communication 3	4Communication 4	5Communication 5
Interest in new things	1Interest in new things 1	2Interest in new things 2	3Interest in new things 3	4Interest in new things 4	5Interest in new things 5
Anxiety in new situations	1Anxiety in new situations 1	2Anxiety in new situations 2	3Anxiety in new situations 3	4Anxiety in new situations 4	5Anxiety in new situations 5

Have they (child 9) expressed an interest in sport before? *

Yes
No

Are they (child 9) currently part of a sports club? *

Yes
No

Would you like to add a tenth child to this application? *

Yes
No

Name of VI Child (10) *

Child (10)'s participation in sport - Please score the named child from 1 (lowest) – 5 (highest) on the following fundamental movement skills: *

	1	2	3	4	5
Running	1Running 1	2Running 2	3Running 3	4Running 4	5Running 5
Walking	1Walking 1	2Walking 2	3Walking 3	4Walking 4	5Walking 5
Jumping	1Jumping 1	2Jumping 2	3Jumping 3	4Jumping 4	5Jumping 5
Catching	1Catching 1	2Catching 2	3Catching 3	4Catching 4	5Catching 5
Throwing	1Throwing 1	2Throwing 2	3Throwing 3	4Throwing 4	5Throwing 5
Kicking	1Kicking 1	2Kicking 2	3Kicking 3	4Kicking 4	5Kicking 5
Balancing	1Balancing 1	2Balancing 2	3Balancing 3	4Balancing 4	5Balancing 5
Bending	1Bending 1	2Bending 2	3Bending 3	4Bending 4	5Bending 5
Twisting	1Twisting 1	2Twisting 2	3Twisting 3	4Twisting 4	5Twisting 5

Please score the named child (10) from 1 (lowest) – 5 (highest) on the following: *

	1	2	3	4	5
Confidence	1Confidence 1	2Confidence 2	3Confidence 3	4Confidence 4	5Confidence 5
Independence	1Independence 1	2Independence 2	3Independence 3	4Independence 4	5Independence 5
Resilience	1Resilience 1	2Resilience 2	3Resilience 3	4Resilience 4	5Resilience 5
Communication	1Communication 1	2Communication 2	3Communication 3	4Communication 4	5Communication 5
Interest in new things	1Interest in new things 1	2Interest in new things 2	3Interest in new things 3	4Interest in new things 4	5Interest in new things 5
Anxiety in new situations	1Anxiety in new situations 1	2Anxiety in new situations 2	3Anxiety in new situations 3	4Anxiety in new situations 4	5Anxiety in new situations 5

Have they (child 10) expressed an interest in sport before? *

Yes
No

Are they (child 10) currently part of a sports club? *

Yes
No

Your preferences

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 (Group leader name) *

VICTA Sport Young Achievers Award – Organisations & Groups

Pre-award Group Information Form

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