2024-Sports-Voucher-Registration-Form

2 x $100 vouchers each calendar year for children in Reception to Year 9

I confirm my child has not already claimed a voucher in 2025

I Confirm

Child's Information

Name

First nameFamily name

Child date of birth

Date

Gender

MaleFemaleGender diverse

Is this the first time your child has joined this activity provider?

YesNo

What is the cost to register for this activity?

Has your child 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 your child from an Aboriginal or Torres Strait Islander background?

YesNo

Medicare Information

Medicare number

Reference number

OR Australian Visa Number:

Parent / Guardian Information

Name

First nameFamily name

Address

Street address

Street Address Line 2

Suburb

Postcode

Contact number

Email

example@example.com

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.