Please complete ALL details.

Your Organisation / School Details
School Name
School Phone Number
School Fax Number
School Address
Organising Teacher's Name
Best Contact Email Address
After Hours Contact Number (for wet weather only)
Year Level of students
Number of Students Attending
Preferred Excursion Date 1
In the event that your requested excursion date becomes unavailable before a deposit is paid, please list your second & third preference dates
Preferred Excursion Date 2
Preferred Excursion Date 3
Any additional comments regarding student group?
Activity Program Required	Gold Rush Survival Team Challenge
Duration	Day Overnight
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