Thank you for participating in the Little Athletics After Schools program with St Marys School. This will be a six-week program delivered by Little Athletics SA Development Officers to introduce participants to running, jumping and throwing events through game-based activities.

The cost for this program is $10 per week and payment can be made at the conclusion of this form.

Question Title

* 1. Particpant's First Name

Question Title

* 2. Partcipant's Last Name

Question Title

* 3. Partcipant's Gender

Question Title

* 4. Participants Date of Birth

Date

Question Title

* 5. Does the student participate in Little Athletics at a Centre (if yes please state which Centre)

Question Title

* 6. Parent/Guardian primary contact email

Question Title

* 7. Parent/Guardian Contact Number

Question Title

* 8. Any medicial or physical issues that coaches should be aware of?

T