Sports Voucher Claim Form

Sports Voucher Claim Form
Are you claiming for 1 x $100 voucher or 2 x $100 voucher
Please complete the below form.

A code will be emailed to you by the Club Treasurer to you to use when registering to offset the Hockey SA fees.

Please do not register to play until you receive a code.
Please complete the below form, then register to play.
Child's Information
Name

First NameLast Name
Gender
Date of Birth

DayMonthYear
Date
Address

Street Address

Street Address Line 2

CityState

Postcode
Medicare Information
Medicare Number
Child's Reference Number
Parent/Guardian Information
Name

First NameLast Name
Phone Number
Email
example@example.com
Background Information
Is this the first time your child has joined this activity provider?
Has your Child been identified as living with a disability?
Is English the main language spoken at home?
If no, what language do you speak at home?
Is your child from an Aboriginal ot Torres Strait Islander background?
Should be Empty:

Child's Information