Diving Secondary Champion Schools Individual Nomination Form

Name: Diving Secondary Champion Schools Individual Nomination Form
SKU: DIVI200-1
Price: 20.00 AUD
Availability: InStock

$20.00

SKU: DIVI200-1 Category: Secondary Champion Schools

Full School Name

I am home schooled

I acknowledge I will be charged an additional fee [+$10.00]

Suburb *

Parent Guardian Last name *

Parent Guardian First name *

Parent Street Address *

Parent Suburb *

Parent Post Code *

Parent Email *

Parent Email confirm *

Parent Mobile *

School Notification *

Student First Name *

Student Surname *

Student DOB *

Gender *

Male

Female

Select Division *

Would you like to try-out for the SSWA State Team? If yes you will be included in the qualifying event. *

Yes

Please adjust quantity required

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