2022 LEADERS Camp Registration
18+
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Email *
First Name
Last Name
DOB *
MM
/
DD
/
YYYY
Age *
Mobile *
Emergency contact (name & number) *
I want to be a camp leader because...
I heard about being a leader through...
City of residence *
I am currently...
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Do you have any dietary requirements? *
Are you a confident swimmer? *
Required
I can make it to these leader trainings...
I can assist with transport...
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. *
I hereby certify that the above statements are true and correct to the best of my knowledge.
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A copy of your responses will be emailed to the address you provided.
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