Rubicon Outdoor Centre
 
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Room Pairs & Student Details On-line Form

* required fields

CAMP No.   Date:    to  

School Name:  *

Camp Contact Name:  *

Camp Contact Email :  *

Camp Contact Phone : 


Please complete lists for male and female students in "room pairs" (two students per room).  It helps us if you can show year levels and where students may have a physical, emotional or intellectual disability.  Please note down any custody issues you are aware of. If it is desirable to separate particular students on activities or duties, please indicate this at the bottom of the form.

Female Room Pairs

  Name Yr level Other details
1
 
2
 
3
 
4
 
5
 
6
 

Male Room Pairs

  Name Yr level Other details
1
 
2
 
3
 
4
 
5
 
6
 


Details of students who should be separated:

  


 

 

 
teacher instructing

 

Rubicon Outdoor Centre
RMB 264, Rubicon Rd.
Thornton, Vic, Australia, 3712
Ph: (03) 5773 2285 or
(03) 5773 2311
Fax: (03) 5773 2441

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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