10 day Registration Form — Mittagundi

Payment Plan/Sponsorship Application

We believe that NO young person should miss out on Mittagundi due to financial constraints:

Use this form to register interest for a payment plan or sponsorship. Your place on the program is not confirmed until a payment installment has been made/your sponsorship request has been successful. We do not offer refunds less than 6 weeks prior to the program, however you are welcome to switch to a later program so please consider carefully prior to making a booking. If you have any questions regarding the bookings form or procedure you can email the Bookings & Communications Manager at info@mittagundi.org.au

Please let us know which program you would like to attend

Please go to '2025 Program Dates' to check what codes are for which dates (e.g. Mixed #516 is from January 8th - 17th January 2025)

Participant Name

First Name

Last Name

Participant Gender

Booking Person's Name

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Booking Person's Email Address

If your child ALREADY has an Operoo account (School / Scouts / other) please use the email address for that account so that we can request to share the profile.

Home Phone Number

Emergency Contact 1. Include name, relationship and mobile number (e.g. Dave, father, 0467 200 000)

Emergency Contact 2. Include name, relationship and mobile number. (e.g Sue, mother 0427 000 000)

Date of Birth

YYYY

Participant's School

Please pick me up from

ALBURY TRAIN STATION

How did you hear about Mittagundi?

Please tell us any social / emotional / behavioural / family issues that we need to consider