Register Your Interest

1Personal Details

2Course & Parent Details

Choose the Course/Programme
Select the programme you wish to register your interest for.
Choose a Programme*
- Senior Journey (ages 14-15 years)
- Junior Journey (ages 11-13 years)
- Go Wild (ages 7-10 years)
- Adventure Skills Development (ages 16-18 years)
- Discover NZ (16-18 years)
- Adventure Therapy (13-16 years)
- Environmental Journey (14-18yrs)
- Adventurous Journey - Duke of Edinburgh's Award (14-18yrs)
Please provide more details:
Which dates / school holidays would you be interested in?
Duke of Edinburgh's Award
Are you counting this programme towards a Duke of Edinburgh Award?
- Yes
- No
Are you already enrolled in the Award?*
- Yes
- No
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*
School Contact Person
(Dean, International Coordinator or equivalent)
School Contact Person Email:

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.
Email
This field is for validation purposes and should be left unchanged.

Please complete this form if you would like register your interest for one of our programmes.

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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Choose the Course/Programme