Register for Purely Girls 2017
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

First Name:
Your answer
Last Name:
Your answer
Age:
Your answer
Email Address:
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 that we need to know about:
Your answer
Please list any allergies that we need to know about:
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:
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
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
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