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 Champion Schools

**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.

Schools Nomination Form 2012

School Details:

School Name:

 

 Suburb: School Phone:

Details of Teacher(s) in Charge: [Note: HOD/TIC Phys Ed and Teacher in charge of this sport both required]

School HOD/TIC Physical Education
First   Surname   Email Mobile

Teacher coordinating this sport in school
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:

Total Number of Competitors To Race:                          

Team Name Submission list - Due Friday 18 May 2012

Click on the attached Excel document and save to your computer. In the relevant cells type team names.

Email this document to the School Sport office at school.sport@det.wa.edu.au

 

School Officials

A condition of entry is your school providing 1 staff official and 2 senior student officials to assist on the competition day if entering more than 10 students or 3 teams.

 

Staff

First Name Surname Mobile Number

Students

First Name Surname DOB

Nominations Due: Friday 18 May 2012

Nomination Fee:$6.00 per person *Subject to change dependent on nomination numbers.(SSWA will invoice schools)

 

When you submit this form it will be emailed to School Sport WA 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