River Safety Course 2nd December 2018
To register for the River Safety course being run by Wellington OTNZ
Course location - Belmont, Lower Hutt. (will depend on river levels)
Morning of Theory and afternoon will be a "little wetter" with practising river crossings.
What is your name? *
First name Last name
Your answer
What is your email address? *
Your answer
Phone number 1 *
The phone we are most likely to reach you on.
Your answer
Phone number 2
An alternative phone number.
Your answer
Date of birth *
Your answer
Address *
Residential address here (followed by postal if different).
Your answer
Medical conditions or special requirements *
Asthma, diabetes, epilepsy, allergies? Sore ankles, knees back etc? List all medication. NA if none.
Your answer
Emergency contact 1 *
Name phone number and relationship of emergency contact (next of kin).
Your answer
Emergency contact 2 *
Name phone number and relationship of another emergency contact.
Your answer
Affiliations - School, Scouts etc.. *
Your answer
Payment $50 - please pay to Outdoor Training 38-90160773412-02
State last name and "River" as a reference.
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