Contact Us – Bushcraft Survival Australia

Name (of person attending course) *

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Last

Name (of person who made the booking) *

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Last

Course Title *

Please choose one of the courses listed

Course Location (Sydney, Coffs Coast, Darwin, Territory Wildlife Park NT) *

Course Date (DD/MM/YYYY) *

Home Address *

Please put your home address, including state and postcode.

Telephone *

Please add your mobile/landline number

Email *

Date of birth *

Male/Female/Non-binary *

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Female
Non-binary

Dietary requirements *

e.g. vegetarian, gluten free, etc

Medical Information *

This is treated with the strictest confidence

Existing medical conditions *

Please give details of any existing conditions

Medications *

Please give details

Allergies *

Please give details

Medicare Number *

Blood group (if known)

(if known)

When did you last receive a tetanus shot?

Primary Emergency Contact *

Please include name and phone number, and relationship

Secondary Emergency Contact *

Please include name and phone number and relationship

How did you hear about us? *

Conditions (please write that you agree and add your name) *

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.

Date of form submitted *

Add today's date.

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