Ultimate Action Camp Application Form

* denotes required field

To apply for the Ultimate Action Camp (teens going into School Years 10-12 or equiv. age) please complete this form. The Camp Committee will meet to allocate places shortly after the application close date. You will be notified by email on the outcome of your application.
1. Camper's name*
2. Camper's date of birth*
3. Camper's address*
4. Camper's email address*
5. Gender*
6. NDSS number*
7. Your parent/guardian's full name*
8. Your parent/guardian's mobile number*
9. Your parent/guardian's email address*
10. How old were you when you were diagnosed with diabetes?
11. Please select any previous diabetes camps you have attended*
12. If you have previously attended a camp, please enter the year/s you attended.
13. Do you have any special dietary requirements?
14. Do you have any allergies or other illnesses/conditions?
15. Do you have any other special needs?
16. How do you manage your diabetes?*
17. Why do you want to attend camp?*
18. If you are selected to attend camp, your parent or guardian will need to pay the $100 camp fee in order to secure your spot. Your place is not guaranteed until we have received payment. If we do not receive payment at least 2 weeks before camp, your place may be released to someone on the waitlist.*
19. I need to apply for financial assistance for the $100 camp fee.*
20. If you answered YES to above - how much of the fee are you able to contribute?

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