Big Night Out Shirley/Aranui!
Access Youth and Wave Youth are partnering with CDN Trust and are going to Flip Out!

Date: Thursday 19th September
Pick up and Drop off at two different locations.
For young people around Mairehau/Shirley area or go to Access Youth meet at 269 Hills Road at 5.00 pm
For young people around Aranui area and or go to Wave Youth meet at 65 Hampshire Street at 5.00 pm
(No pick ups and drop offs at Flip Out)
Time: 5.00 pm - 7.00 pm
Bring Grip Socks if you have them!

On Arrival please sign in at our welcome desk.
CDN Trust takes photos/video during activities for promotional use (including posting appropriate photos/videos to our websites and Facebook) On signing this form you also give consent for photos/videos taken on the night to be used by CDN Trust, Access Youth and Wave Youth.
CDN Trust & C3 Eastside will have staff onsite who are qualified in first aid.
If you have any queries about these Policies or Terms and Conditions please contact Jasper at either
022 165 6633 or

Staff and volunteers are trained in health and safety and leadership skills. We will always have at least one Leader trained in first aid on every program. You authorise us to administer any medical care urgently required.
This event is for young people who are in years 7-8 (generally aged around 10-13). Staff to child ratio is max 1:10 (Leader/children) for activities at a base, and 1:6 for programme's away from a specific venue.
We are a Christian organisation and we may share some Biblical principles on this programme.
Please be aware that because safety is our first consideration our policy needs to be strictly adhered to. Parents will be phoned if their children are causing disruption to the programme. Where serious harm may occur the child/children will be removed immediately. Parents must be able to pick up their child from events/camps/programmes if necessary.
Our camps and programmes regardless of the weather, however certain activities may be weather and availability dependent. If we are forced to change activities on a programme due to weather or other circumstances we cannot refund fees.
Young people must wear proper (safe) clothing for all activities

CDN Trust wishes to collect the personal details for the purposes of program registration and evaluation. You have the right to access and check any details you have supplied. All the information gathered will be used in accordance with the Privacy Act 1993
Student Last Name: *
Your answer
Student Last Name: *
Your answer
Gender: *
Date of Birth: *
Address: *
Your answer
Your answer
Your answer
Year Level: *
Your answer
Ethnicity: *
Dietary Requirements we should know of:
Your answer
Other Relevant Information CDN Trust should be aware of (Behavioural, Medical etc):
Your answer
Do you have pair of Grip Socks to bring for Flip Out ? *
Meeting Place? *
Where will you meet us (5.00pm) & get picked up at the end of the night (7.00pm)?
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