Application to attend the NZCPA "Road to 2019-2022" Development Camp
Use this form to apply to join the NZCPA Road to 2019-2022 Development Camp to be held in Palmerston North on 13th and 14th January 2018.

Our aspiration is to help players not currently in the 2018 NZ squads prepare for future national honours at the 2019 Oceania, 2020 World Championships and beyond.

Please read through this section carefully before filling in all sections of the form.

The closing date for applications is the 3rd December 2017 at 6pm

The cost of the camp is $300 for all players.

The cost of the camp includes; accommodation on Friday and Saturday nights, breakfast, lunch and evening meal on Saturday and breakfast and lunch on Sunday, transport to and from lagoon and the Palmerston North Holiday Park.
Players attending will receive a Development Camp t-shirt, this is ONLY for those attending the camp.

The cost of the camp excludes travel to and from camp although transport will be provided for those flying into and out of Wellington. NZCPA will arrange a van and boat transport for those player flying into Wellington.

Players from Northern, Mainland and Deep South regions my apply for a $100 travel subsidy. Please send request to BEFORE the camp.

The primary method of communication will be via a Facebook closed group;
NZCPA Road to 2019-2022 Development.

Information may also be shared by email and through our website;
It will be your responsibility to check for information and keep yourself up to speed with the information shared.

The camp is limited to 60 players, hopefully 30 each male and female. We will have a number of elite coaches at the camp offering a wide range of skills and advice. Area's covered (but not limited too) will include specialist training is the following: Goalie/ Physical preparation/ Gym/ Mental skills/ Tactics/ speed work/ boat skills

At the end of the camp we plan to announce a boys and a girls NZ Development Team, these teams will be invited to play at the Atahua Cup in Palmerston North on the 3rd and 4th February 2018.

Payment is required before the 24th December 2017.

PARENTS, please contact me directly if you are able to help out with the organisation and/or running of the camp. Many hands make light work and will also help us deliver a hugely beneficial camp for our stars of the future.

Please email the Squads Director at if you have any questions

Email address *
Untitled title
Players Personal Details
Please fill in the details of the person wishing to apply
First Name/Names *
Your answer
Surname Name *
Your answer
Gender *
Email address *
Your answer
Mobile phone *
Your answer
Home phone *
Your answer
Full Postal Address *
Your answer
Date of Birth *
Next of Kin
Please provide details of your next of Kin
Full name *
Your answer
Relationship to Squad Member *
Your answer
Full Postal Address *
Your answer
Home phone number *
Your answer
Work phone number *
Your answer
Mobile phone number *
Your answer
Email address *
Your answer
Special Dietary Requirements *
Your answer
Medical Conditions / Allergies / Medications *
Your answer
Proof of Membership:
Complete the details of the Club and National League team you play for along with the details of the person within your club who can confirm you are financially affiliated to the New Zealand Canoe Polo Association.

The Squad Manager will also contact this person to confirm you are financially affiliated to the New Zealand Canoe Polo Association as part of the application process.

Canoe Polo Region *
Your answer
Canoe Polo Club *
Your answer
National League Champs Team: *
Your answer
Name (club contact) *
Your answer
Their position within club *
Your answer
Their email address *
Your answer
Their mobile number *
Your answer
I have contacted the person named above who has confirmed I am financially affiliated to the New Zealand Canoe Polo Association. *
Camp t-shirt
All players will be provided with a camp t-shirt, this is strictly for those attending only.
Please choose your size below
Women's Sizes
Men's Sizes
Code of Conduct
All players are obliged to follow the following code of conduct;

• Respect the rights, dignity and worth of others.

• Do not engage in any form of abuse, harassment, discrimination, or victimisation towards others.

• Be fair, considerate and honest in all dealings with others.

• Accept responsibility for your actions.

• Be aware of and maintain adhesion to rules, guidelines, and policies.

• Never argue with or verbally abuse an official. Always use the appropriate rules and guidelines to resolve a dispute.

• Do not use obscene language.

• Conduct yourself in a sportsman-like manner and respect fellow players, coaches, managers,
officials, and the achievement of opponents.

• Cooperate with your coach, managers, and team mates.

• Comply with training, competition, curfew, and behaviour requirements directed by New Zealand Canoe Polo while in camp and on tour.

• Do not engage in sexual behaviour while in camp or on tour.

• Do not possess or consume prohibited substances while in camp and on tour.

• Do not consume or purchase alcohol and tobacco while in camp or on tour without the agreement of the manager and coach.

• Be a positive role model.

• Have respect for New Zealand Canoe Polo property and the property of others.

• Never act in a way that may bring disrepute or disgrace to New Zealand Canoe Polo, its members, stakeholders, and sponsors/potential sponsors.

I have read the code of conduct and agree to uphold it when representing the NZCPA both on and off the water *
I consent to the information on this form being used by the New Zealand Canoe Polo Association and its regions to compile mailing lists and other data which may be distributed to competition organisers, funding bodies, sponsors and parent bodies of the New Zealand Canoe Polo Association.
This consent is given in accordance with the Privacy Act 1993.

I agree to abide by all relevant clauses in the Selection and Squad Guidelines. I understand that I am obliged to pay my share of all Squad costs, and have an understanding of the magnitude of those costs.

A non-refundable application fee of $100 must be paid into the Squad Account; 02 0876 0048375 002. This must be paid at the time of applying. Please reference the payment with the players name and development. *
Are you over 18 years old? *
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