Queen's Guide Retreat Registration Form Question Title * 1. Contact Details Full Name Address Address 2 City/Town Postal Code Email Address Phone Number Question Title * 2. Guardians Contact Details Full Name Address Address 2 City/Town Postal Code Email Address Phone Number Question Title * 3. What is your date of birth? DD/MM/YYYY Date Question Title * 4. Year at School Question Title * 5. Area Upper North (A) Central Area (B) Lower North (C) South Area (D) Question Title * 6. Hub Hub 1 - Te Tai Tokerau Hub 2 - Tamaki Makaurau Hub 3 - Tamaki ki te Tonga Hub 4 - Te Puku o te Ika Hub 5 - Te Tai Rawhiti Hub 6 - Te Tai Hauauru Hub 7 - Te Whanganui a Tara Hub 8 - Te Waipounamu Question Title * 7. Unit Name Question Title * 8. ID Number Question Title * 9. Which retreat do you wish to apply for: Wellington - 12-14 April 2019 Auckland - 28-30 June 2019 Rotorua - 19-21 July 2019 Christchurch - 11-13 October 2019 Question Title * 10. Please put your second choice Question Title * 11. My Ranger Leader is aware of my application to attend the retreat Yes No Question Title * 12. What is your leaders name? Question Title * 13. Date you completed your Peak Award Date / Time Date Question Title * 14. Dietary Requirements Terms and Conditions Question Title * 15. I give you permission to contact my leader to ascertain my suitability for this event. Yes Question Title * 16. My emergency contact and personal details on OGM are up to date Yes Question Title * 17. I understand this trip needs to run at full capacity for fixed costs to be covered. Therefore should I withdraw after acceptance, a refund will only be given if a replacement is found. If I withdraw because of medical reasons a partial refund may be available on presentation of a medical certificate. Yes Question Title * 18. I understand payment must be made at least 21 days prior to the retreat Yes Question Title * 19. I acknowledge that I am responsible for all travel costs and that I am not to book travel until I have received the acceptance letter, which will advise suitable arrival/departure times. I will travel by Air, which I will arrange myself Other public transport (bus/train) which I will arrange myself Private car on my own or with others, which I will arrange myself I am not sure at this time Question Title * 20. Is there any other information we should know which may assist with your application? Done