Fillable $100 VOUCHER Y ONE VOUCHER FOR EVERY PRIMARY (Services Australia)

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$100 VOUCHER Y ONE VOUCHER FOR EVERY PRIMARY (Services Australia)

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The $100 VOUCHER Y ONE VOUCHER FOR EVERY PRIMARY (Services Australia) form is 1 page long and contains:

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  • 14 check-boxes
  • 52 other fields

Country of origin: AUSTRALIA
File type: PDF

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Services Australia, (previously DHS - Department of Human Services) is responsible for delivering services relating to health and welfare of Australian citizens. It processes payment of child support other services.

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To be presented at an approved Sports Voucher provider. To find your nearest provider or for more information please
visit www.sportsvouchers.sa.gov.au. Not redeemable for cash, only a reduction to membership/registration fees.
Redemption value not to exceed $100.00. In presenting this voucher I give permission to the Sports Voucher provider to
share my information with the Office for Recreation, Sport and Racing.
$100 VOUCHER
ONE VOUCHER FOR EVERY
PRIMARY SCHOOL AGED CHILD
PER CALENDAR YEAR
An email notification may be sent to the above email address (assuming it is correct) advising the authorisation of the voucher used for your child
To be presented at an approved Sports Voucher provider. To find your nearest provider or for more information please
visit www.sportsvouchers.sa.gov.au. Not redeemable for cash, only a reduction to membership/registration fees.
Redemption value not to exceed $100.00. In presenting this voucher I give permission to the Sports Voucher provider to
share my information with the Office for Recreation, Sport and Racing.
An email notification may be sent to the above email address (assuming it is correct) advising the authorisation of the voucher used for your child
Child first name:___________________________________ Family name:______________________________________________
Child date of birth:________/________/
__________ Gender:
Medicare number:_____________________________________________ OR Australian visa number:________________________
Suburb:_________________________ P
ostcode: Member of a sport/dance group prior to using voucher:
Parent/Guardian first name:_________________________ Family name:______________________________________________
Contact number:__________________________________ I confirm my child has not already claimed a voucher in 2021:
Parent/Guardian Email:
_______________________________________________________________________________________
Child date
of birth:________/________
/__________ Gender:
Medicare number:_____________________________________________ OR Australian visa number:________________________
Suburb:_________________________
Postcode: Member of a sport/dance group prior to using voucher:
Parent/Guardian first name:_________________________ Family name: ______________________________________________
Contact number:__________________________________ I confirm my child has not already claimed a voucher in 2021:
Parent/Guardian Email:
_____________________________________________________________________________________
__
Ref. no.
Ref. no.
F
My child is attending or is eligible to attend primary school (Years R-7) in 2021: Y Y
Child first name:___________________________________ Family name:_____________________________________________
N
N
M
F
My child is attending or is eligible to attend primary school (Years R-7) in 2021:
Y
N
Y
$100 VOUCHER
ONE VOUCHER FOR EVERY
PRIMARY SCHOOL AGED CHILD
PER CALENDAR YEAR
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$100 VOUCHER Y ONE VOUCHER FOR EVERY PRIMARY (Services Australia)

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Completed 21 June 2021

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