Boys & Girls State Registration Form

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* 1. Gender

Male

Female

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* 2. Mailing Address

First Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Applicant (Non-school) Email Address

Applicant Phone Number

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* 3. Date of Birth

Date / Time

Date

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* 4. High School

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* 5. Parent's Name

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* 6. Parent's Phone Number

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* 7. Parent's Email Address

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* 8. Medical Issues / Allergies

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* 9. Do you have any special food / dietary requirements?

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* 10. Applicant acknowledges the below list of documents will need to be submitted prior to 1 May 2023.

Medical Questionnaire

School & Post Signature Page

Delegate and Parent Pledge Form

Media Release Form

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* 11. Shirt Size

Extra Small

Small

Medium

Large

XL

2XL

OTHER