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Junior Blades Application Form
Member demographics(Race) are required by the Department of Sport & Recreation for statistical purposes
Please do not use all caps to complete the form and please use names that you would like to appear on your child's certificates and badges
 
Parent/Guardian Details
Name (*)
Please let us know your name.
Surname (*)
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Date of Birth (*)
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ID Number (*)
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Your Race (*)
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Gender (*)
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Email (*)
Please let us know your email address.
Alternative Email
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Telephone Home
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Telephone Work
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Telephone Cell (*)
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Postal Address (*)
Please enter a valid postal address
Postal Code (*)
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Child 1 Details
Child 1 Name (*)
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Child 1 Surname (*)
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Child 1 Date of Birth (*)
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Child 1 ID Number (*)
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Child 1 Gender (*)
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Child 1 Race (*)
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Child 1 Medical Conditions
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Child 2 Details
Child 2 Name
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Child 2 Surname
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Child 2 Date of Birth
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Child 2 ID Number
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Child 2 Gender
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Child 2 Race
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Child 2 Medical Conditions
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Child 3 Details
Child 3 Name
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Child 3 Surname
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Child 3 Date of Birth
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Child 3 ID Number
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Child 3 Gender
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Child 3 Race
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Child 3 Medical Conditions
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Child 4 Details
Child 4 Name
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Child 4 Surname
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Child 4 Date of Birth
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Child 4 ID Number
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Child 4 Gender
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Child 4 Race
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Child 4 Medical Conditions
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Captcha (*) Captcha
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