First Name *

Surname *

Home Phone

Mobile Number

Email *

Address

Town

State

Post code

Male Or Female Male Female *

Date of Birth

I Check my Email Regularly Yes No

I’m Happy to receive communications by Email Yes No

Do you Work or Attend School School Work

If @ School What Grade are you in?

School Attending

What Church do you Attend

Camp1 (30/5/10—4/6/10) Grade's 3-5

Camp2 (6/6/10—11/6/10) Grade's 5-7

Camp 1 Yes No Maybe

Camp 2 Yes No Maybe

Camp1(5/9/10—10/9/10) Grade's 3-5

Camp2(12/9/10—17/9/10) Grade's 5-7

Camp 1 Yes No Maybe

Camp 2 Yes No Maybe

Camp1 (9/1/11—14/1/11) Grade's 3-5

Camp2 (16/1/11—21/1/11) Grade's 5-7

Camp3 (23/1/11—28/1/11) Grade's 6-8

Camp 1 Yes No Maybe

Camp 2 Yes No Maybe

Camp 3 Yes No Maybe

Room Leader Yes No

Supervisor Yes No

Study Leader Yes No

Camp Parents Yes No

Grandma & Grandpa Yes No

Pastoral Care Yes No

Head of Kitchen Yes No

Kitchen Helper Yes No

Aunty or Uncle Yes No

Have you attended Riverbend’s Leadership Training if so when was the last time?

If you are over 18yr’s is your Police Check up to date Yes No

Is your Leaders Application Form current,no more than 2 Years old Yes No

Or do you feel like you need to update your Leaders Application details Yes No

Do you Have a Leaders Hand Guide Yes No

Have You Read Leader Hand Guide Yes No

Other Comments

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