Primary Cross Country Individual Nomination

**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 appropriate sport coordinator.

Nomination Form 2012 - Individual Competitor 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.   Competitor Details: First Name Surname DOB       Please select the race you wish to enter.. Able Bodied Categories: Yr 5 Boys  Yr 5 Girls  Yr 6 Boys  Yr 6 Girls  Yr 7 Boys  Yr 7 Girls    Athlete with Disability   Please type in your: AWD Classification:                          AWD Distance required in meters:     Nominations Due: Thursday 9 August 2012 Nomination Fee:$5.00 (inc GST) per person *Subject to change dependent on nomination numbers. [Payment to be made on the day] When you submit this form it will be emailed to the Sport Coordinator, Daryl Mansfield South Perth PS Tel: 93672652 Daryl.Mansfield@det.wa.edu.au   **Please print a copy of the form before submitting for your own records**   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