Membership Form

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Membership Form

This form will sign you up to be a member of Adventure Therapy Aotearoa from 1 May 2021 - 31 April 2022.

Adventure Therapy Aotearoa is a networking association and as such holds no responsibility for the competence, qualifications or practice of individuals or organisations who are a part of the membership. We ask that members identify their interest in and experience of adventure therapy when they join the association, and that they accept and agree in good faith an ethical statement.

Adventure Therapy Aotearoa (ATA) reserves the right to decline membership of any individual who they ascertain do not practice within the broad parameters of adventure therapy or who have engaged in unlawful and/or unethical practice.

ADVENTURE THERAPY AOTEAROA ACCOUNT NUMBER 38-9020-0523950-00

First Name *

Last name *

Organization

Email *

Where are you from? *

Central North Island

NZ european *

NZ European

Iwi (if applicable)

No *

Does your professional association have a code of ethics? *

N/A

Adventure therapy has been newly introduced to me. I have a graduate degree, and graduate certificate in psychology and am just now venturing into the Adventure and Outdoor tourism sphere with the goal of becoming an instructor at Outward Bound *

I understand that Adventure Therapy is the intentional use of nature, adventure, outdoor and /or experiential based interventions as part of a therapy for a group or individuals. *

Yes

I understand that ATA exists to support the development of safe and ethical practice of Adventure Therapy in New Zealand/Aotearoa through connecting Adventure Therapy practitioners. *

Yes

I understand that ATA honours the principles of the Treaty of Waitangi. We recognize the indigeneity of Māori in the increasingly culturally diverse New Zealand. We promote and support cultural competencies. *

Yes

I am aware that adventure therapy requires me to be aware of, and adhere to safe practices both in the outdoor adventure space through adhering to Adventure Activity regulations, and also the therapeutic space through operating within my professional scope. I understand that Ethics for both therapeutic work and outdoor adventure work apply in this approach. *

Yes

Financial: I agree to pay an annual subscription of $60.00 ($40.00 unwaged). Half the membership subscription will be payable if I am joining after November 15th. ATA bank account number: 38 9020 0523950 00 Please put your name in the reference and donation in particulars. *

Yes

I understand that my contact details may be made available to other members. *

Yes

I understand that in addition to annual membership subscription I may donate through a one-off payment or automatic direct debits if I wish to further support the development of Adventure Therapy in New Zealand/Aotearoa. ATA bank account number: 38 9020 0523950 00 Please put your name in the reference and donation in particulars. *

Yes

In regards to payment... *

I have paid - I require a receipt please...

If you require an invoice please enter details here.

I agree to all above things - I'm in!! Before you click the button, please logon to your internet banking and pay..... go on, you'll just forget to do it later otherwise! *

Yes!!! Count me in :-)

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