Register for Purely Girls 2019
Please fill in all sections of this form and then click the submit button at the bottom of the page - if any section does not apply to you, then please just type N/A in that section.

Once your form has been submitted, we will reply by email in 2 - 3 days
Please Note: Purely Girls Dates Are:
4pm Tues 23 April 2019
Ends: 12pm Sat 27 April 2019

Email address *
First Name: *
Your answer
Last Name: *
Your answer
Age: *
Your answer
Home Address (please include the suburb and city): *
Your answer
Home Phone Number: *
Your answer
Mobile Number: *
Your answer
Please list any health or medical conditions *
Your answer
Please list any allergies *
Your answer
Please list any any special medications you will need to bring to camp: *
Your answer
Please list any special dietary requirements you have: *
Your answer
Please choose which applies to you: *
Please pay to: Purely Girls Westpac 03-0578-0130530-000 Put Full name as reference
Your answer
Do you agree to participate in camp activities and to abide by the Purely Girls Camp rules found at: www.family.org.nz *
This section is for a parent or caregiver to fill out
Full details about the Purely Girls camp can be found at: www.family.org.nz
Parent/Caregiver's Full Name: *
Your answer
Parent/Caregiver's daytime phone number: *
Your answer
Parent/Caregiver's after-hours phone number: *
Your answer
Parent/Caregiver's email address: *
Your answer
Will you be attending the banquet on Friday evening? Banquet cost is $40 pp *
If YES above, please list names of anyone else coming below
Your answer
Do you give permission for your daughter to attend the Purely Girls camp? *
Are there any other details you would like us to know?
Your answer
How did you hear about Purely Girls?
Your answer
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