Course registration form

Please fill in this form/questionnaire as part of the registration process for the Community Exercise Foundation Course.  Your answers will help ensure we provide a course tailored to the needs of all course attendees.  Once received, course tutor Kris Tynan will be in touch to confirm your place and arrange payment. The course fee is ONLY $30! Or $50 for 2 people from the same organisation!

The information we collect as part of the registration process is used by us for planning and reporting purposes. You have the right to access and correct any personal information held by us. You can also choose to remove your details from our database at any time and we will not share your information with third parties.

For more information about the course please visit the Active Canterbury website or contact Kris Tynan on kris.tynan@xtra.co.nz or 021 262 8886.

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* 1. Name:

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* 2. Organisation (or group/s you are involved with) -  for example, church, marae, community group

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* 3. Contact email:

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* 4. Contact phone no:

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* 5. Please describe your previous exercise/fitness instruction experience:

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* 6. Do you have a current first aid certificate?

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* 7. Please tell us what you most want to learn about - tick all the boxes that apply

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* 8. Please tell us more about the people who come to your class/group (or you would like to work with in future) - specifically the ethnicity and demographics of attendees (e.g. age, gender, special pop etc)

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* 9. To gain a course completion you must be able to attend the full course.  Please confirm below that you are able to make this commitment.

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* 10. Please tell us how you heard about this course (we appreciate your feedback)

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