NORTH SHORE BOOST APPLICATION

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Thursday 14th October , Friday 15th October, 9am - 2.30pm Northcote College

Name: *

School: *

Age: *

Address: *

Parents Email: *

Parents Mobile : *

Organised sport or Physical Activities I do on a regular Basis *

ETHINICITY *

NZ european

Maori

Pacifika

Asian

Other

I would consider myself to be :(Please note we are looking for girls who are less active but want to be more active.) *

Very active , I do organised sport/activity more than 7 hours a week a week

Active , I do organised sport / activity more than 4 hours a week

Minimal , I do organised sport / activity less than 4 hours a week

I can attend all three days *

YES

Do you have any medical conditions ? *

Can we use your photo in TDF promotional material including social media *

YES

Binding Agreement *I have signed this on my own behalf. By submitting, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature. I have signed this on my own behalf and on behalf of the student as a parent or in locus parenti. *

Submit

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