Registration form

*1.Please entre full name(Required.)

*2.Age and date of birth(Required.)

*3.If you are under the age of 18 you will need an adult supervision, please provide their name?(Required.)

*4.Contact number(Required.)

*5.Clan group(Required.)

*6.Do you need transport (Please note: that a Rekindling the Spirit employee will contact you either a pick up destination/ time or meeting place and time.)(Required.)

Yes

No

*7.Do you have any allergies? If yes provide some information(Required.)

8.Do you have a chronic illness? If yes, please provide some information

*9.Do you have limited mobility?(Required.)

Yes

No

*10.Are you bringing a support person? If yes who?(Required.)

*11.Do you understand that this event is a smoke free, drug and alcohol-free event?
If you are under the influence of AOD you will be asked to leave.(Required.)

Yes

No