EMR Snorkel Guide Training Registration
Nga mihi - Thank you  for your interest in signing up to the Experiencing Marine Reserves - Te Kura Moana  Snorkel Guide Training for volunteers and taitamariki/rangatahi. Details about the programme are provided in the programme outline - please request a copy if you do not already have one. We will contact you to confirm your place in the programme.
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Email *
What session would you like to attend? *
First Name *
Last Name *
Date of birth *
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Contact phone number *
Acknowledgment of risk. I hereby acknowledge the risks associated with snorkeling. I understand that the EMR programme will identify any foreseeable risks or hazards and implement correct management procedures to eliminate or minimise those hazards. *
Dietary Requirements *
Medical Conditions? *
Required
Please elaborate on medical conditions, if any *
Emergency contact details
Please use someone that is local
Name *
Relationship *
Contact phone number *
Skills/Experience - Select those that apply *
Required
Drug and alcohol policy
By signing this form you agree to abide by MTSCT - EMR’s drug and alcohol policy which includes not being under the influence of drugs or alcohol when onsite or involved in MTSCT - EMRs activities and safety sensitive sites.
Parent/guardian information
The parent/guardian is responsible for ensuring the participant has transport to/from the training. In some cases we may be able to arrange car pooling, but this must be arranged and confirmed in advance. The parent/guardian will be given access to the relevant RAMS form/s and the participant will be given a full Health and Safety briefing from the supervisor prior to the training session. The parent/guardian and participant reserve the right to refuse participation in any part of the programme if they feel harassed or unfairly treated or unsafe.  

The Trust reserves the right to cancel this agreement at any time.
Risk Disclosure
Health and Safety policies and Standard Operating Procedures are found on our programme websites. Before each event parents/guardians and participants will be given access to the relevant RAMS form/s or event plans for the site and given a full Health and Safety briefing from the supervisor, including (but not limited to) the identification of potential risks and management strategies.  Participants will be verbally briefed about the activities and potential hazards, location of first aid, facilities and emergency procedures on the commencement of every activity. Site familiarisation is undertaken and relevant issues explained wherever these arise.  

Complaints procedure is to advise the Trust Chairperson of any complaints or concerns, which will be dealt with by the Trust. Feedback and/or complaints can also be submitted via our website
http://www.emr.org.nz/information.php?info_id=190
Liability Statement
I accept that any medical costs associated with accidents are to be classified as non work related and will be paid for by the ACC or other means and under no circumstances by the Mountains to Sea Conservation Trust. The Mountains to Sea Conservation Trust does not accept any responsibility whatsoever for any personal accident or loss/damage to personal items or equipment of participants whilst they are engaged in this programme.

Parent/guardian Declaration
In entering your name and date below you give permission for your child to participate in the programme. You also declare that you understand the risks and liability outlined above.
Date *
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Full name *
A copy of your responses will be emailed to the address you provided.
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