Membership 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

* Required field
Parent/Guardian Details:
Name (*)		Surname (*)
Date of Birth (*)		ID Number (*)
Your Race (*)		Gender (*)
Email (*)		Alternative Email
Telephone Home		Telephone Work
Telephone Cell (*)
Postal Address (*)
Suburb (*)
Postal Code (*)

Child 1 Details:
Child 1 Name (*)		Child 1 Surname (*)
Child 1 Date of Birth (*)		Child 1 ID Number (*)
Child 1 Gender (*)		Child 1 Race (*)
Child 1 Medical Conditions

Child 2 Details:
Child 2 Name		Child 2 Surname
Child 2 Date of Birth		Child 2 ID Number
Child 2 Gender		Child 2 Race
Child 2 Medical Conditions

Child 3 Details:
Child 3 Name		Child 3 Surname
Child 3 Date of Birth		Child 3 ID Number
Child 3 Gender		Child 3 Race
Child 3 Medical Conditions

Child 4 Details:
Child 4 Name		Child 4 Surname
Child 4 Date of Birth		Child 4 ID Number
Child 4 Gender		Child 4 Race
Child 4 Medical Conditions