2021 LEADERS Camp Registration
Year 13 and up
Email address *
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... *
Do you have any dietary requirements?
Are you a confident swimmer? *
Required
I can make it to these Leader Trainings... *
Required
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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