Contact Us Please enable JavaScript in your browser to complete this form.Name (of person attending course) *FirstLastName (of person who made the booking) *FirstLastCourse Title *(Please select one)1 Day Survival Essentials Course2-Day Junior/Family Bushcraft Survival CourseFundamental Module 1 Bushcraft Survival CourseFundamental Module 2 Bushcraft Survival CourseIntermediate Module 3 Bushcraft Survival CourseFundamental Modules 1 & 2 Bushcraft Survival CoursePlease choose one of the courses listedCourse Location *(Please select one)Sydney, NSWCoffs Coast, NSWDarwin, NTVictoriaPlease choose one of the courses listedCourse Date *(Please select one)15-18 April 202124-25 April 202129 April - 2 May 202113-16 May 202129 May - 1 June 202129 May - 5 June 20211-5 June 20216 June 202110-13 June 20213-6 July 20216-10 July 20213-10 July 202118 July 202121-25 July 20212-5 October 20212-9 October 20215-9 October 202114-17 October 202123-26 October 202126-30 October 202123-30 October 20213-7 November 2021Please choose one of the courses listedHome Address *Please put your home address, including state and postcode.Telephone *Please add your mobile/landline numberEmail *Date of birth *Male/Female/Non-binary *MaleFemaleOtherDietary requirements *e.g. vegetarian, gluten free, etcMedical Information *This is treated with the strictest confidenceExisting medical conditions *Please give details of any existing conditionsMedications *Please give detailsAllergies *Please give detailsMedicare Number *Blood group (if known)(if known)When did you last receive a tetanus shot?Primary Emergency Contact (Name, relationship, number) *Please include name and phone number, and relationshipSecondary Emergency Contact (Name, relationship, number) *Please include name and phone number and relationshipHow did you hear about us? *FacebookWebsiteTwitterBrochuresOtherI acknowledge and understand the BSA COVID-19 Policy and Procedures *YesNo I acknowledge and understand that by participating in this course and by signing this Consent Form, I am declaring the following: That I recognize that outdoor programs involve some inherent risks. That I am of sufficient physical fitness to participate in the course. That I am prepared to abide by safety policies, camp rules and staff instructions set out by Bushcraft Survival Australia. I will not hold Bushcraft Survival Australia or its instructors and staff liable for any loss or damage to personal property or for any injuries sustained during the course. I give permission for basic medical requirements to be administered by the instructors in situations necessary to prevent death or further injury. Permission for photos and/or video footage involving me to be taken on this course which may be used in media promotions. Subject to unforeseen circumstances, weather conditions, or if group numbers are not sufficient, Bushcraft Survival Australia reserves the right to cancel a course. In such cases a full refund will be given. *Please type your full name in the box above to acknowledge you have read and agree to the conditions above. Date of form submitted *Add today's date.MessageSubmit