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Adventurer Application Form
A form to register your interest in joining the Dice 4 Diversity community and joining our adventures.
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* Indicates required question
Email
*
Your email
Adventurers Name
*
Your answer
Age
*
Your answer
Parent/Carer/Registering party name (if different)
*
Your answer
Email
*
Your answer
Phone number
Your answer
Location (Canberra south side unavailable)
Choose
Canberra - Macquarie (northside)
Yass/Goulburn
Interstate - by teleconference
If interstate, where?
Your answer
Age group
*
Primary School Yr 4-6
High School Yr 7-10
17 - 25 yrs
25+ yrs
Primary School - My Little Pony
Preferred session times
AM - between 9-12
PM - between 12:30-3:30
Afterschool - 4:00-6:00
Evening - 6:30-9:30
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
AM - between 9-12
PM - between 12:30-3:30
Afterschool - 4:00-6:00
Evening - 6:30-9:30
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Clear selection
Further information
Your answer
A copy of your responses will be emailed to the address you provided.
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