SRC and Bronze Camp
Apply now for SRC and Bronze Camp. Please complete all required fields to submit your Expression of Interest.
Participants Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: 0000 000 000.
Participant Email
*
example@example.com
Age
*
Date of Birth
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Gender
Please Select
Male
Female
Other
Club
Please Select
Arcadian
Ayr
Eimeo
Forest Beach
Mackey
Sarrina
Townsville Picnic Bay
Whitsundays
Which camp are you applying for?
Please Select
SRC Camp
Bronze Camp
Guardian Name
*
First Name
Last Name
Guardian Email
*
example@example.com
Guardian Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
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Next
Do you have any Medical History?
*
Yes
No
If answered "Yes" above please provide further details.
Do you take any medication?
*
Yes
No
Do you require assistance in taking your medication or is it self-managed?
Self-Medicated
Yes I require assistance
Please provide further information on how we can assist you.
Do you have any Dietary Requirments?
*
No
Yes
If answered "Yes" above please provide further details.
Medicare Number
*
Do you have Private Health Insurance?
*
Yes
No
Please Provide insurer details
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Next
Emergency Contact 1
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Email
*
example@example.com
Relationship (e.g Mother, Father)
*
Emergency Contact 2
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: 0000 000 000.
Email
example@example.com
Relationship (e.g Mother, Father)
Submit Application
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