Camp ELECT at Longbeach Registration
Parent/Guardian First Name *
Your answer
Parent/Guardian Surname *
Your answer
Student First Name *
Your answer
Student Surname *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Contact Phone *
Your answer
Mobile Phone
Your answer
Address 1 *
Your answer
Address 2
Your answer
City *
Your answer
State / Province *
Your answer
Post Code *
Your answer
Country *
Your answer
Country of Birth *
Your answer
Nationality *
Your answer
Passport Number *
Your answer
First Language *
Your answer
Other Languages Spoken
Your answer
Do you have any Siblings? *
Will they be joining you at Camp?
What is your current English Proficiency *
Do you have any of the following English tests?
Have you traveled away from your parents before?
Would your parents like to holiday in AUS while you are at camp? (we can provide helpful information)
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