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1 Child's details

First/Given names*(AS SHOWN ON PASSPORT)
Last Name*(AS SHOWN ON PASSPORT)
Preferred Name*
Gender
D.O.B (dd/mm/yyyy)*
/ /
Current school*
Height*
in Centimeters
Weight*
in Kilograms
Current team*
Current position*
Proof of ID (Type of document)
Professional status
Playing for school team
Country of birth*
Nationality*
Registered to play
Former National Association*
Former Registered Number in different association*
FFA number*
Club played last year*
Address*
Postcode*
Emergency contact number*
Preferred Email*
Preferred contact number*
Preferred mobile number (for SMS alerts)
Mother email
Mother mobile
Father email
Father mobile

2 Medical information (please answer all questions)

Does your child suffer from any of the following
Please provide any necessary information
My child's level of swimming is
Doctors Name
Doctors Number
Medicare Number

3 Payment options

Please select*

4 Other details:

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