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Hillary Outdoors Enrolment Consent Form_PROGRAMMES
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Which programme/event are you enrolling in? Once you have completed your online application, you will be emailed an invoice. Your place on the course is secured once payment is received. *
Centre/Event Attending *
Arrival Day *
Arrival Date *
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Departure Date *
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PARTICIPANT DETAILS
First Name *
Last Name *
Date of Birth *
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Age - minimum age of 18 years *
I identify as a *
Ethnicity
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E-mail *
Mobile Phone *
Street/Rural Address *
Suburb *
City *
Post Code *
Country *
NEXT OF KIN / EMERGENCY CONTACT
Next of Kin First Name *
Next of Kin Last Name *
Relationship to participant *
Email
Next of Kin mobile *
Next of Kin home phone
Next of Kin Work Phone
PERSONAL INFORMATION
Hillary Outdoors has a policy of inclusion.  In order to achieve this safely it is vital that we have as much information as possible about our participants.  It is ESSENTIAL that you give us accurate and detailed information. Note: Any information provided will be treated as confidential.

IF ANYTHING CHANGES BETWEEN COMPLETING THIS FORM AND THE TRIP IT IS ESSENTIAL YOU LET US KNOW.
Dietary details (if required). Examples include:  vegetarian, gluten-free, dairy-free, lactose intolerant etc. *
Medical conditions (if required). Examples include: injuries, allergies, anxiety, diabetes, obesity, behavioral, addiction, sight or hearing impediments etc. *
Details of medication (if required). Examples include: epipen, inhaler, antihistamine, acne medication etc *
Medical Administration. I agree to me/my child being given over the counter medication. Example: Panadol or Ibuprofen *
If other, please explain:
Please select the technical gear you need to borrow. *
Required
Do you have a Mount Ruapehu Season/Life chairlift pass?
*
Experience relating to the course and what you hope to get out of the course. *
Media release
Photos and videos of participants on our courses and programmes may occasionally be used for marketing purposes.  
Do you give consent for photos and videos of you/your child to be used for marketing purposes? *
CONSENT
Detailed information about our safety system and activities is provided at www.hillaryoutdoors.co.nz/safety/

IN SUMMARY:
- Hillary Outdoors offers a wide range of activities which may include: kayaking, canoeing, tubing, river walking, rock-climbing, ropes courses, abseiling, camping, tramping, caving, skiing, snowboarding, and snow skills.
- Participation in all activities at Hillary Outdoors is voluntary although participants are supported and encouraged by their peers and instructor to participate to a level which challenges them.
- Because of the changeable and unpredictable nature of the outdoors risks can never be reduced to zero.  Hazards exist in these activities that may result in serious injury or even death.  These hazards include:  weather / environmental conditions, height, water, equipment, Hillary Outdoors employees' behaviour and skills, client specific hazards, environmental impact and vehicles.
- Our goal is that no harm will occur whilst involved in activities.  Our management strategies for achieving this can be viewed online.

PLEASE CONTACT US IF YOU REQUIRE MORE INFORMATION TO MAKE A DECISION, OR IF YOU HAVE ANY QUESTIONS
Please read each statement and then indicate your consent below.
- I understand there are risks associated with outdoor activities that cannot be reduced to zero. I know I am able to ask any questions of Hillary Outdoors or the individual instructor to gain a better understanding of the activity before deciding whether to take part, and the final decision about whether to take part or not is mine. If I decide to take part, I understand the instructor will identify any hazards that are liable to arise and correct procedures to deal with these, and that it is necessary for me to follow these. The instructor will take all reasonable precautions to ensure my safety. If I act outside of this advice, then I acknowledge I do so at my own risk and may be instructed to leave the programme or activity.

- I have received enough information to make an informed decision about the programme I am about to undertake.

- I authorise Hillary Outdoors to instigate medical assistance and treatment required in an emergency.

- I understand I may be charged for items belonging to Hillary Outdoors I lose or damage.

- I understand that my personal effects are not covered by Hillary Outdoors insurance policy.

- I understand that if I am under the influence of alcohol, drugs or other substances, Hillary Outdoors has the right to stop my further participation on the programme and I have no right for refund of my course fee.

- I have read the information sent to me and agree to act within Hillary Outdoors' policies and expectations. I understand that Hillary Outdoors cannot be responsible for storage or administration of my medication, unless specifically requested to do so prior to their visit.

- I understand Hillary Outdoors Tongariro operates in an area with active volcanoes with associated risks. For
further information please see:
https://www.doc.govt.nz/parks-and-recreation/places-to-go/central-north-island/places/tongariro-national-park/know-before-you-go/volcanic-risk-in-tongariro-national-park/ 

PLEASE CONTACT US IF YOU REQUIRE MORE INFORMATION TO MAKE A DECISION, OR IF YOU HAVE ANY QUESTIONS
Covid19 policy and information
Please ensure you have read and understand our policies https://www.hillaryoutdoors.co.nz/hillary-outdoors-covid-19-policy/

Photos and videos of participants to our courses and programmes may occasionally be used for marketing purposes.  We assume your permission to any of you unless otherwise requested by you.

By completing your name and the date below you are confirming that the information provided is as accurate and as complete as possible and you are confirming your participation in the stated Hillary Outdoors programme.
I, the participant, agree with ALL of the above. *
Participant's Date of Agreement *
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Marketing. Please tick the box if you do NOT want to receive information from Hillary Outdoors.  At no time will your information be sold to anyone else.
How did you hear about us? *
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