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Quad bike competition online entry form
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Quad bike competition online entry form
Required fields are marked with an asterisk (
*
).
Entry form
Title
-- Please Select --
Miss
Ms
Mr
Mrs
Family/surname
Given name
Date of birth
*
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Home postal address
School year
Name of school
Daytime contact number
Mobile
Email
Video link
Entry type
*
-- Please Select --
Video
Poster
Photo
Quad bike safety message used
Children under 16 should not ride or be passengers on farm quad bikes
Helmets save lives
Always wear your seatbelts in ssvs
Choose safe ways to get around the farm
Please upload your entry
Parent/guardian consent
Parent/guardian name
I have read and agree to the competition’s terms and conditions and give my permission to SafeWork NSW to use my child’s name and competition entry and any other information I provide in connection with the ‘Quad bikes are not toys – keep kids safe’ competition.
The personal information submitted via this form will be held and used by SafeWork NSW in accordance with their
privacy statements
.
*
Please tick to agree
Date (DD/MM/YYYY)
*
Day
0
Month
Dec
Year
2018
Parent/guardian email
Parent/guardian phone
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