Contact Us – Bushcraft Survival Australia

Name (of person attending course) *

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Name (of person who made the booking) *

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Course Title *

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Course Location *

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Course Date *

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Home Address *

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Telephone *

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Email *

Date of birth *

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Dietary requirements *

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Medical Information *

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Existing medical conditions *

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Medications *

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Allergies *

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Medicare Number *

Blood group (if known)

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When did you last receive a tetanus shot?

Primary Emergency Contact (Name, relationship, number) *

Please include name and phone number, and relationship

Secondary Emergency Contact (Name, relationship, number) *

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How did you hear about us? *

I acknowledge and understand the BSA COVID-19 Policy and Procedures *

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 *

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