Camper Inquiry

Submitted by admin on Fri, 04/07/2014 - 12:53pm

For more information about being a camper at Camp Cooinda, please fill out the form below.

Please check the Summer Camps page and the Frequently Asked Questions page prior to sending the form as they may answer your query.

First Name *

Last Name *

Nickname

Email *

Gender

Birth Date *

Day

Month

Year

Mobile Phone Number

Please include spaces (eg 0412 345 678)

Home Phone Number

Please include spaces (e.g. 03 9876 5432)

Street Address *

Street Address Line 2

City *

State/Province *

Postal Code *

Country *

Refer Source *

Please select how you first found out about Camp Cooinda?

Your enquiry *

By submitting this form, you accept the Mollom privacy policy.