To be eligible, you need to be in the zones of the Whau, Henderson-Massey and Waitakere Boards. If you would like to take part in our event, please fill in your details in this Event Registration Form below. From there we will send you confirmation within 5 work days.

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* 1. Participant's First Name

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* 2. Participant's Last Name

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* 3. Email Address

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* 4. Street Address

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* 5. Suburb

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* 6. Postcode

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* 7. Gender

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* 8. Date of Birth

Date

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* 9. Age (at time of programme)

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* 10. Ethnicity

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* 11. Name of Iwi (if applicable)

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* 12. Country of Birth

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* 13. Programme (pick ONE only)

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* 14. Medical Concerns

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* 15. Please advise any other medical concerns which could effect your participation in any activities or any other special instructions that your Instructor should know about:

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* 16. Are you confident in water?

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* 17. Are you able to swim 200m non-stop?

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* 18. Parent/Caregiver/Guardian First Name

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* 19. Parent/Caregiver/Guardian Last Name

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* 20. Emergency Contact - Name

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* 21. Emergency Contact - Phone

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* 22. Terms and Conditions

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* 23. How did you hear about our Break-Away School Holiday Programmes?

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