sports voucher program – claim form

NORTH ADELAIDE LACROSSE CLUB (INC)
ESTABLISHED 1887
Terama Street, Gepps Cross
PH. 8260 4561
PO BOX 292 Enfield Plaza S.A 5085
ABN 55 408 519 338
SPORTS VOUCHER PROGRAM – CLAIM FORM
In order to claim your Sports Voucher (for fees only, not for equipment hire), we require you
to supply the below information. Please pass completed form onto your Child’s Coach.
Please note – the information requested below, is what the SA Gov. ask us to supply when
claiming a Sports voucher. This data will not be used by NALC or supplied to any third party
other than SA Gov. as per the voucher claim process.
Child's Information
First Name
Surname
Gender
Date of Birth
Street Address
Suburb
Postcode
Medicare or Australian Visa Number
Parent's Information
First Name
Surname
Contact number
Used a voucher this calendar year?
Member of a sports club prior to using
voucher?
Aboriginal or Torres Strait Islander?
Culturally and linguistically diverse
background?
Please contact me directly (using below details) or speak to me at training with any questions
you may have.
Thank you,
Gemma
Gemma Charles - Chairperson 2015
North Adelaide Lacrosse Club
Phone – 0400 251 467
Email – [email protected]
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