Claim $200

Claim $200
for children in Reception to Year 9
This voucher is for 1 x $100
Note: 2 x $100 vouchers can be combined to put $200 towards one activity under the same provider. Alternatively, 2 x $100 vouchers can be split between two different providers where a maximum of $100 can be put towards each activity. Please indicate using the appropriate tick box above.
Name

First NameFamily Name
Gender
Child date of birthDD

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

SuburbState / Province

Postal / Zip Code
Postcode
OR Australian visa number
Medicare number
Reference number
Parent/Guardian information

First NameFamily Name
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 Plus provider. To find a registered provider or for more information please visit sportsvouchers.sa.gov.au. Not redeemable for cash, only a reduction or refund of sport, active recreation or music tuition fees. Redemption value not to exceed 2 x $100. In presenting this voucher I give permission to the Sports Voucher Plus provider to share my information with the Office for Recreation, Sport and Racing (ORSR The ORSR may share information to the Commonwealth Government for the purpose of validating the identity of a child with Medicare and with third parties (including research institutions or organisations) to improve the administration, outcomes or effectiveness of the program.
Is this the first time your child has joined this activity provider?
Has your child been identified as living with a disability?
Is your child from an Aboriginal or Torres Strait Islander background?
Is English the main language spoken at home?
If no, what language do you speak at home?
What is the cost to participate in this activity?
Should be Empty: