SCHOOL SPORT WA

PO Box 8224, Perth Business Centre, WA 6849  ABN: 25 492 318 440  school.sport@det.wa.edu.au

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Cross Country Individuals

**Enter your details and press submit at the bottom of page**

Please do not print a blank form and hand write your details as your nomination will not get through to the sport coordinator.

Individual Nomination Form 2012

School Details:

School Name:

 

 Suburb: School Phone:

Details of Parent/Teacher in Charge: [Note: Person attending with the student on the day]

Parent/Teacher Information
First   Surname   Email Mobile

Important: All relevant sport information and competition updates will be sent to these email addresses

Principal Authority:

A condition of participation is schools compliance with Department of Education Policies and Guidelines as they relate to excursions.  My school Principal is aware of, and endorses, this team(s) nomination.      

Yes (Please click)

Principal's Signature:____________________________________

For School Records Only: We suggest you print this form, present to your Principal and keep for your records - you are not required to bring this to the event or submit to the SSWA office.

 

Competition Details:

First Name Surname DOB
     

Please select the race you wish to enter....

Able Bodied Categories:

12 year old BOYS

12 year old GIRLS

13 year old BOYS

13 year old GIRLS

14 year old BOYS

14 year old GIRLS

15 year old BOYS

15 year old GIRLS

16 year old BOYS

16 year old GIRLS

17 year old BOYS

17 year old GIRLS

 

Athlete with Disability

 

Please type in your:

AWD Classification:                         

AWD Distance required in meters: 

Nominations Due: Friday 18 May 2012

Nomination Fee: $6.00 per person *Subject to change dependent on nomination numbers.

Payment is to be made on the day of competition

 

When you submit this form it will be emailed to www.school.sport@det.wa.edu.au   

.**For your records please print a copy of the form before submitting**

 

For security reasons we require you to enter a code word prior to hitting the submit button.

Code Word [use lowercase]: sswa       Enter code word here