Interstate Online Registration 2022 SSWA State Team*Please Select Your Sport BelowAFL 15s BoysNetball 15sFootball (Soccer) 16s BoysFootball (Soccer) 18s GirlsSwimming 10-12 YrsSwimming 13-19 YrsFootball (Soccer) 12s BoysFootball (Soccer) 12s GirlsHockey 12sHockey 16sAFL 15s GirlsCross CountryBasketballAquathlonTriathlonTennis-Pizzey CupPlease complete this form using correct title case (upper and lower) Has the student been in an SSWA Interstate team previously?* Yes No Will you be purchasing any uniform?* Yes No Student DetailsName* First Last Preferred first name (If different from above) Date of Birth* Day Month Year Gender* Male Female Full School Name* Home Postal Address* Street Number and NameSuburb* Post Code* Student Mobile Number* Student Email* Enter Email Confirm Email Are you an Aboriginal or Torres Strait Islander?* Yes No Parent/Guardian 1 DetailsName* First Last Relationship to Student* Parent 1 Mobile* Is Parent 1 Home Postal Address the same as the Student Home Postal Address Above?* Yes No Address* Street AddressSuburb* Post Code* Parent 1 Email* Enter Email Confirm Email Occupation* Parent/Guardian 2 DetailsName First Last Relationship to Student Parent 2 Mobile Is Parent 2 Home Postal Address the same as the Student Home Postal Address Above?* Yes No Address* Street AddressSuburb* Post Code* Parent 2 Email Enter Email Confirm Email Occupation Student Travel ArrangementsTravel Options* My child will travel to the SSA Championship with a parent or nominated guardian My child is unable to travel with a parent or nominated guardian Reason why student is unable to travel with a parent or nominated guardian* Financial Parent work Commitments Other Please outline reason*Parent ResponsibilityI will assume responsibility for* All costs associated with travel and accommodation Transporting my child to each sporting competition Caring for my child should they become unwell during the National Championships Ensuring I have completed the SSWA online travel information form at least 1 week prior to travel Please check all boxesI accept the following requirements with this option** I will cover all costs associated with this travel option Should my child contract COVID-19 I will be requested to travel and accommodate with my child throughout the isolation period I will be contactable by phone at all times throughout the travel period SSWA staff will administer a RAT if my child has symptoms or identified as a close contact Asymptomatic students identified as close contacts whilst on tour will adhere to the current protocols at the time of travel. Please check all boxesMedical InformationMedicare Number* Do you have Private Health Cover?* Yes No Name of Health Fund* Member Number* Does your child have any known allergies?* Yes No Please indicate the type of allergy* Drug Food Other Please provide details*Is your child subject to asthma, fainting, epilepsy, diabetes or any other condition that may affect his/her safety during this interstate experience?* Yes No Please provide details*Do you know the date of your child's last Tetanus injection?* Yes No Year of last Tetanus injection* Medication DetailsIs your child currently taking any medication.* Yes No Does your child self administer the medication.* Yes No Please provide details of the medication including type, dosage and frequency of use.*Medication ConsentIn the event your child sustains an injury or becomes ill, do you give permission for staff to administer the medication listed below?Analgesics containing paracetamol i.e. Panadol* Yes No Anti-Inflammatories containing Ibuprofen i.e Nurofen* Yes No Provide further information if requiredDietary RequirementsDoes your child have any special dietary requirements.* Yes No Please indicate the special dietary requirements.* Additional InformationPlease provide any additional medical or personal information that may enable the team management to provide better care for your child.Swimming Ability and Water Based Excursion AuthorityStudents may need to access swimming facilities for recovery or other sessions as indicated by coaches/managers. They will be fully supervised at all times. We need to be aware of your son/daughter's swimming ability.Permission is given for my son/daughter to participate in water based activities under the supervision of SSWA officials* Yes No Please indicate your child's swimming ability* Non Swimmer Weak Swimmer Competent Swimmer Strong Swimmer I am unsure of my child's swimming ability Please detail your assessment of your child's skills and abilities in relation to the aquatic activities.*Emergency Contact - Please provide an emergency contact, other than listed parents.Name* First Last Mobile* Relationship to Player* Media Contact PermissionPrior to travel we send a Media Release to the Local Community Newspapers. Please indicate below if you give us permission to provide Parent Number One's contact details to any Media Outlet that requests this information in order to publish an article.Do you give consent for parent number one's contact details to be passed on to media outlets, upon request?* Yes No Upload Team Acceptance FormAccepted file types: jpeg, jpg, pdf, doc, docx, Max. file size: 10 MB.The completed Team Acceptance Form can be uploaded here or emailed separately to email@example.com.CommentsThis field is for validation purposes and should be left unchanged.