2024 Sports Vouchers

I confirm my child has NOT already claimed a voucher in 2024:*

We have not claimed a voucher for this child in 2024

Child's Name*

Child first nameFamily name

Child's date of birth:*

Date

Gender:*

MaleFemaleGender diverse

Is this the first time {childsName} has joined this activity provider?*

YesNo

What is the cost to register for this activity?

Dartmoor Costs - U9 $100 - U13 $165 - U16 $205

Has {childsName} been identified as living with a disability?*

YesNo

Is English the main language spoken at home?*

YesNo

If no, what language do you speak at home?

Is {childsName} from an Aboriginal or Torres Strait Islander background?*

YesNo

I will provide my child's:*

Medicare NumberAustralian Visa Number

Medicare number:

Child's Medicare Ref. no.

Number located by child's name on card

Australian visa number:

Parent/Guardian Name*

First nameFamily name

Street Address:*

Suburb:*

Postcode:*

Parent/Guardian Contact Number:*

Parent/Guardian Email:*

An email notification may be sent to the above email address (assuming it is correct) advising the authorisation of the voucher used for your child

To be presented at an approved Sports Voucher provider. To find your nearest provider or for more information please visit www.sportsvouchers.sa.gov.au.

Not redeemable for cash, only a reduction to membership/registration fees. Redemption value not to exceed $100.00.

In presenting this voucher I give permission to the Sports Voucher provider to share my information with the Office for Recreation, Sport and Racing (ORSR). The ORSR may share de-identified information with third parties (eg other agencies of government, research institutions, etc) to improve the administration, outcomes or effectiveness of the Program.

$100 VOUCHER - 2024