Child Details

Child First Name

Child Surname

Child Gender

Male

Female

Gender Diverse

Child Date of Birth

(DD/MM/YYYY)

Address

Suburb

Child Postcode

Child Identification

Medicare Number

Australia Visa Number

Child Australia Visa Number

Medicare Number

10 digits

Medicare Childs Reference Number

Single digit after child's name on card

Parent/Guardian Details

Parent/Guardian First Name

Parent/Guardian Surname

Parent/Guardian Phone Number

Email

Have you already claimed your Sport Voucher this year?

Yes

No

You can only claim 2 x $100 vouchers per child per calendar year

How many vouchers are you claiming?

1 voucher ($100)

2 vouchers ($200)

Is your child already enrolled in the program?

Yes

No

Your child must be enrolled to claim. First enrol in the program, then submit this form.

Is your child in school (reception - year 9)?

Yes

No

The SA government has restricted Sport Vouchers to children of Primary and High School age

Has your child been identified as living with a disability?

Yes

No

Is English the main language spoken at home?

Yes

No

If no, what language do you speak at home?

Is your child from an Aboriginal or Torres Strait Islander background?

Yes

No

Location

Which YMCA Centre is your child currently enrolled?

Terms & Conditions

By submitting this form I confirm my child's Sport Voucher has not yet been used this calendar year and qualifies for the Sport Voucher initiative (Reception to Year 9). I also understand that it may take up to 15 business days for the Sport Voucher credit to be applied to my account. Credit will automatically be used to pay for future YMCA programming debits and is non-refundable. Lastly, I consent to sharing this information with the Office for Recreation, Sport and Racing.

I agree/understand

Please note that this is a generic YMCA form. Kindly select your local Y Centre in the form above.

Sports Vouchers

Child Details

Parent/Guardian Details