KIWI ADVENTURES BOOKING FORM

Please complete this booking form and we will send you the details of the trip/s

Please note: spaces are limited and we don't want anyone to miss out, so please make sure you can attend this trip. If you can no longer attend the trip please let us know in advance (not just the night before). If you fail to let us know you will be barred from the next trips.

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Full Name

Student I.D Number

Date of Birth

Phone Number

Your Current Address

Emergency Contact Number

Medical Conditions

Heart Conditions

Epilepsy

Diabetes

Asthma (Mild or Severe)

Allergies

Knee/ankle/back/shoulder problems

Previous health difficulties whilst exercising or adventuring etc?

Is there anything else staff should know about your health to assist you in the trip?

By clicking the box below I am confirming I have read the Terms and Conditions for the SANITI's Kiwi Adventure.

I accept the Terms and Conditions for SANITI's Kiwi Adventures.

Signature

Date

By ticking this box you are confirming you are a current NMIT Student.