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 (*) ---AsianBlackColouredIndianWhite Gender (*) ---MaleFemale 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 (*) ---MaleFemale Child 1 Race (*) ---AsianBlackColouredIndianWhite 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 ---MaleFemale Child 2 Race ---AsianBlackColouredIndianWhite 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 ---MaleFemale Child 3 Race ---AsianBlackColouredIndianWhite 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 ---MaleFemale Child 4 Race ---AsianBlackColouredIndianWhite Child 4 Medical Conditions