Working With Children Check Application Form
Information:
Please ensure all your personal details are accurate on this form. SwimmingSA will assess your suitability for a Working With Childrens Check and if deemed appropriate submit an application to the Screening Unit on your behalf. The Screening Until will then send you an email and request you complete your application.
Full Name
*
First Name
Middle Name
Last Name
E-mail
*
Date of Birth
*
-
Day
-
Month
Year
Date
Are you a SwimmingSA Member?
*
Yes
No
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Please Select your Club
*
Adelaide Masters
Alma Broken Hill
Aquadome Otters Masters
Atlantis Masters
Barossa
Berri
Blue Lake Y
Booleroo Centre
Broken Hill Aquatic
Burra
Clare
Clovercrest
Clovercrest Masters
Crystal Brook
Dolphins
Gawler
Gladstone
Great Southern
Great Southern Masters
Henley Beach Masters
Henley & Grange
Immanuel Piranhas
Jamestown
Keith
Kent Town
Loxton
Mallee
Marion
Marion Marlins Masters
Masters SwimmingSA
Mildura Masters
Mountain Pool
Mt Gambier
Murray Bridge
Noarlunga Masters
Norwood
Onkaparinga
Onkaparinga Masters
Orroroo
Payneham
Payneham Masters
Penola
Playford Aquatic
Port Augusta
Port Augusta Masters
Port Pirie
Quorn
Roxby Downs
STARplex
Silver City
Southern Performance
Tea Tree Gully
Tea Tree Gully Masters
The Parks
Unattached SA
Unley
Vitor Renmark
Waikerie
West Coast
Western Aquatic
Western Districts Masters
Whyalla
What Position are you fulfilling within the sport? (Select multiple if applicable)
*
Carer - Athlete with a Disability
Coach
Club Committee Member
Contractor
Team Manager
Technical Official
Volunteer
Other
Do you already have a valid WWCC, DHS or DCSI Screening
*
Yes
No
Please enter your Reference number
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