Please be assured your answers will remain confidential.

*1.Name of Participant/s(Required.)

Participant 1

Participant 2

Participant 3

Participant 4

Participant 5

*2.Age of Participant/s(Required.)

Participant 1

Participant 2

Participant 3

Participant 4

Participant 5

3.Gender of Participant/s

Gender

Participant 1

-- Select an option --Woman/GirlMan/BoyNon-binaryPrefer not to say

Participant 2

-- Select an option --Woman/GirlMan/BoyNon-binaryPrefer not to say

Participant 3

-- Select an option --Woman/GirlMan/BoyNon-binaryPrefer not to say

Participant 4

-- Select an option --Woman/GirlMan/BoyNon-binaryPrefer not to say

Participant 5

-- Select an option --Woman/GirlMan/BoyNon-binaryPrefer not to say

4.Dose the Participant/s have a disability?

Disability

Participant 1

-- Select an option --YesNoNot SurePrefer not to say

Participant 2

-- Select an option --YesNoNot SurePrefer not to say

Participant 3

-- Select an option --YesNoNot SurePrefer not to say

Participant 4

-- Select an option --YesNoNot SurePrefer not to say

Participant 5

-- Select an option --YesNoNot SurePrefer not to say

*5.What is your local government area?(Required.)

Baw BawBass CoastEast GippslandLatrobeSouth GippslandWellingtonOther (please specify)

6.What club, school or organisation are you from (if any)?

7.Details of the person submitting the entry form

Full Name

Email

Phone number

Address