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The programme will be running for 5 weeks only during term 1 this year.
Start date: Tuesday, 11 March
Ending Tuesday, 8 April
From 3 pm - 5.30 pm
Meeting and pick up point is Warihi Park
Parent / Guardian Information
Parent / Guardian Name:
*
First name
Last name
Mobile:
*
Email:
*
Would you like to receive / continue receiving the Karioi E-News?
*
Yes
No
Relationship to Participant
*
Emergency Contact Information
The Parent / Guardian info will be used as the first emergency contact. Please list at least one alternative emergency contact person.
Emergency Contact Name:
*
First name
Last name
Mobile:
*
Email
*
Relationship to Participant
*
+ Add another emergency contact
- Remove emergency contact
Participant Information
Participant's Name:
*
First name
Last name
Date of Birth:
*
School:
*
- Other
Homeschool
Raglan Area School
RAS Roopu
Te Mata School
Te Uku School
Waitetuna School
Health / Dietary Information
Allergies
*
No
Yes
Asthma
*
No
Yes
Diabetes
*
No
Yes
Seizures/Epilepsy
*
No
Yes
Dietary Requirements
*
No
Yes
If YES to any of the above, please provide medical/allergy/dietary details:
Comfortable with water activities?
*
No
Yes
Registration Details
Please enter 1 to select the programme for this child. Your booking is only valid once payment has been received. Thanks!
Tuesday afternoons
T1 2025 Karioi Kids Programme (7-8 years)
$50.00
$
Comments / Questions
If any of the above programmes is listed as "None available" it means we have full enrollment for that programme. Please let us know if you'd like your child to be waitlisted in case a space becomes available.
+ Add another child
- Remove child
Payment Details
Payment method:
*
Credit / Debit Card (NZ card)
Internet Banking (NZ only)
Account Name: A Rocha Aotearoa New Zealand
Account Number: 03-1563-0419360-00
The account details will be emailed to you upon SUBMIT so that you can complete your payment.
Processing fee for payment by credit card
$
Total amount to pay
$
Cancellation and Refund Policy
Please read the Cancellation and Refund Policy as outlined in the linked document below.
Please click to review:
Cancellation and Refund Policy - Karioi Kids and Karioi Rangers
I agree to the Cancellation and Refund Policy
*
Photo Permission & Disclaimer
I GRANT permission for photos that include the above participant(s), without any other personal identifiers, to be published on the Karioi Project website and/or social media.
*
No
Yes
By submitting this form, I the parent/guardian agree to my child(ren) participating in Karioi Kids or Karioi Rangers programme. This includes going to various places in the Whaingaroa area and beyond that could include Mt. Karioi, surrounding bush, streams, beaches etc. Activities could include physical and challenging activities such as hiking, swimming, trapping predators, climbing trees, jumping off walking bridge etc.
Please check the highlighted fields
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