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2023 LEADERS Camp Registration
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* Indicates required question
Email
*
Your email
First Name
Your answer
Last Name
Your answer
DOB
*
MM
/
DD
/
YYYY
Age
*
Your answer
Mobile
*
Your answer
Emergency contact (name & number)
*
Your answer
I want to be a camp leader because...
Your answer
I heard about being a leader through...
Your answer
City of residence
*
Your answer
I am currently...
In high school
In university/ graduated high school
working
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Do you have any dietary requirements?
*
Your answer
Are you a confident swimmer?
*
Yes - Can swim 50 meters
Yes - Can swim in deep water
Yes - Can tread water
No
Required
I can make it to these leader trainings...
10 December 2022
21 Jan 2023
I can assist with transport...
To camp
From camp
I cannot assist
I hereby consent to images/videos taken from the project that might feature me, to be released for the purposes of media releases, reporting and promotion of the project.
*
Yes
No
I hereby certify that the above statements are true and correct to the best of my knowledge.
Yes
No
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A copy of your responses will be emailed to the address you provided.
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