Sports Voucher Claim Form

Sports Voucher Claim Form
Are you claiming for 1 x $100 voucher or 2 x $100 voucher*

$100.00$200.00
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*

MaleFemaleGender Diverse
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?*

YesNo
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 ot Torres Strait Islander background?*

YesNo
Should be Empty:

Child's Information