Register Interest in Duke of Edinburgh's Award

1Personal Details

2Course & Parent Details

Award Details
Are you already enrolled in the Award?*
- Yes
- No
Choose an Award Level*
- Bronze
- Silver
- Gold
Please provide more details:
Which dates / school holidays would you be interested in?
Participant's Personal Details
Student Name*
First Name Last Name
Preferred Name
Date of Birth*

Day
Month
Year
Age*
Gender*
- Male
- Female
- Gender Diverse
Current School*

Parent / Caregiver Contact Information
Parent Name*
Please enter your name
Relationship to participant applying*
Home Phone*
Parent Mobile*
Parent Email*
Parent Address*
Street Address Address Line 2 City ZIP / Postal Code
Would you like to receive our newsletter for future programme dates?*
- Yes
- No
Further Information:
Thanks for registering your interest with us. If you have any specific queries or have further information to add, please use the box below.
Phone
This field is for validation purposes and should be left unchanged.

Please complete this form if you would like register your interest in completing part of your Duke of Edinburgh's Award with us.

Feel free to contact us if you have any questions.

375 Main Rd, Lower Moutere,
Nelson Tasman, New Zealand
Postal Address:
RD 2, Upper Moutere, 7175
New Zealand

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Award Details