Pride Escape Enrolment

Cub details










Medications handed into Supervisor during programme?


Can we apply sunblock to your cub?



Cub's Doctor


 

Parents/Caregivers details

Name

 


Is your cub a confident swimmer?



Not sure

 

Emergency contact

Name Phone

Name Phone

 

Persons other than parents authorised to collect your cub

 

Permission for trip days

I give consent for my cub(s) to go on trips with the Pride Lands team during this Pride Escape expedition.
I understand the conditions of Pride Lands (see “conditions” on our website: www.pridelands.org.nz).
I agree to abide by these terms.


 

Is there anything els we should know about?

Can we photograph your cub?


Would you like to recieve a monthly newsletter?



I understand the conditions of Pride Lands and agree to abide by the terms.

required

 

Survey (optional)

How did you hear about Pride Lands?

Is there anything we could improve?

 

This information is private and confidential. Thank you for your support.