Enrolment form - 2019 harness racing education program
The Western Region Academy of Sport (WRAS) are pleased to provide an education program for junior drivers (aged 11 to 17 years of age). The theory and practical program is endorsed by Harness Racing NSW.

The program will be held in Bathurst on Saturday 16 and Sunday 17 March 2019.

Enrolments close: 9am Thursday 21 February 2019.

Parent/guardian permission to publish images and release athlete information
WRAS will provide Harness Racing NSW will participant's name, email address, phone number, date of birth and home town. Images of participants may be used by WRAS and Harness Racing NSW for promotional purposes and may be released to the media. Media may attend this WRAS event and take photos/videos for news items.
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Athlete's personal details
First name *
Your answer
Surname *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Gender *
Email addres *
Your answer
Postal address *
Your answer
Town *
Your answer
Postcode *
Your answer
Current school year *
School currently attending *
Your answer
Are you of Aboriginal or Torres Strait Islander decent? *
(for statistical purposes could you please answer)
Do you have a disability? *
(for statistical purposes could you please answer)
Medical Information and Consent
Medicare number (please include all 10 numbers) *
Your answer
Medicare reference number (the number next to your name) *
Your answer
Medicare expiry (eg 08/2020) *
Your answer
Do you have any medical conditions that WRAS should know about? *
Details of medical conditions
Your answer
Medication approved by parent/guardian *
Approval given
Approval declined
Paracetamol (eg Panadol)
Ibuprofen (eg Nurofen)
Disprin (asprin)
Athlete has been immunised against tetanus *
Date of most recent tetanus booster *
Your answer
Declaration and authority
*
Required
Parent/guardian details
First name and surname of parent/guardian - 1st contact *
Your answer
Phone number of parent/guardian - 1st contact *
Your answer
Email address of parent/guardian - 1st contact *
ALL information (trial details, selection advice, offer to be part of the WRAS 2019 program) will be sent to the email address you provide - it is important that this is an email address that you check regularly.
Your answer
First name and surname of parent/guardian - 2nd contact (optional)
Your answer
Phone number of parent/guardian - 2nd contact (optional)
Your answer
Email address of parent/guardian - 2nd contact (optional)
ALL further information will also be emailed to the address you provide below
Your answer
Please select a shirt size from the options below
Please note: Womens sizes are small sized with not much stretch - it is recommended you select a size at least one size larger than you would normally wear.
Captionless Image
Dietary requirements
Please provide details of any special dietary requirements that WRAS need to be aware of.
Your answer
Enrolments close 9 am on Thursday 21 February 2019
The WRAS office must receive the enrolment form by the closing date. Your nomination will be acknowledged by email..
For further information please contact the WRAS office
For further information please contact the WRAS office by phone 6338 4821 or email info@wras.org.au
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