Youth Program Application

Required fields are marked with red dots.

About You

First Name
Surname
Address
Suburb / Town
State
Postcode
Date of Birth
Email
Home Phone
Mobile
What KCYP branch do you want to join?
Are you currently studying?		No Yes
What are you Studying?		Note: Please include your year level and school/course name below.
Please tell us about yourself
What do you know about Kokoda?
What do you hope to achieve by participating in the Kokoda Challenge Youth Program?
How do you think the Kokoda Challenge Youth Program might influence your future?
Who do you feel will support your involvement in the program? (please specify family members, friends, youth worker etc)
Can you please tell us about your known or anticipated time commitments in 2010 (work, family, etc)
How would you rate your level of fitness?		Very Unfit Somewhat Fit Fit Very Fit
Do you have any known medical conditions?

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