Valley Campus online booking form

Valley Campus Online Booking
Group Name*
What is the purpose of your program?*
What resources do you require to help run the program?*
Please provide a brief outline of your program*
Preferred arrival date*

DayMonthYear
Preferred departure date*

DayMonthYear
Alternate arrival date

DayMonthYear
Alternate departure date

DayMonthYear
Arrival time*

:HourMinutesAM/PM Option
Departure Time*

:HourMinutesAM/PM Option
Estimated number of people attending:
Children < 15 years*
Adults*
Adult/instructor to particpant ratio*
Breakdown of males and females*
Will you need access to the kitchen?*

YesNo
Does your group have Public Liability Insurance?*

YesNo
Does your group have a Risk Management Plan?*

YesNo
Contact Details:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

PostcodeCountry
Phone Contact
E-mail
Any other details?
Should be Empty: