School Sport ACT ?? Summary

Name of Student *

School *

Date of Birth *

Gender *

Medical Conditions* Please ensure this information is up to date.

Allergies* Please ensure this information is up to date.

Date of last Tetanus Shot *

Medicar Number *

Preferred Emergency Contact*

Preferred Emergency Contact Number *

Student Email *

Student Mobile Phone Number *

I confirm that the above information is correct. *

I agree to abide by the School Sport ACT Code of conduct. *

I have read and agree to the School Sport ACT Acceptance process. *

Back to Step 03 Confirm and Submit

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