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2021 LEADERS Camp Registration
Year 13 and up
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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 Highschool
In University
Working
Other:
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...
*
22 November 2020
13 December 2020
18 January 2021
Required
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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