State —Please choose an option—ACTNSWQLDSATASVICWAInternational
Emergency contact - name
Emergency contact - number
Emergency contact - relationship
Do you have any food allergies?
Special dietary requirements
Prior to completing this section please read the code of code here.
yes I have read, understood and agree to the Camp Widow Australia code of conduct.
Prior to completing this section please read the photo consent agreement here.
I agree and provide my photo consent:YesNo
Is the above agreement subject to any conditions or limitations?