Application to attend the NZCPA "Road to 2021-2024" Development Camp
Use this form to apply to join the NZCPA Road to 2021-2024 Development Camp to be held in Palmerston North on 14th and 15th December 2019.

The purpose of this camp is to provide the next generation of our athletes with the skill sets to improve their level of play and challenge for positions in our future national teams.

We will assemble a large contingent of coaches and elite national players to provide top level coaching and benchmarking. This is open to all players who have mastered the basic skills.
Application is via this on-line application form.

The costs of the camp is $200 for South Island and Upper North Island players (Hamilton and Auckland) and $300 for everyone else.

Camp will be assembling on the evening of Friday the 13th December.
When booking your flights can you please aim to be in Wellington by 5pm on Friday evening.
We will provide transport from Wellington to Palmerston North.

We will confirm the details around boat transport in the coming weeks however for those flying and do not want to bring their own boat there may be an option to hire a boat from Polo Mania or JC Polo. Please contact them directly to check availability. This way you could then possibly fly directly into Palmy.

On the Sunday camp will finish around 2 pm with a view to getting those flying checked in in-time for flights from 5pm onwards.

Those flying can you please book your flights early so as to keep costs to a minimum.

Accomodation will be at the Palmerston North Holiday Park. We have allowed for a number of beds for parent helpers, please let me know if you are able to help out with organising and running the camp.

Breakfast, lunch and dinner will be provided on the Saturday and breakfast and lunch on the Sunday.
Players will need to bring drinks and any additional snacks they may need.

The main channel for communication will be through the closed FaceBook page “NZCPA Road to 2021 - 2024 Development Camp” Players and at least one parent will need to join this group.

The camp fee can be paid into the following account; 02 0876 0048375 002. Please use Dev Camp and the players name as the reference.

PARENTS, please contact me directly if you are able to help out with the organisation and/or running of the camp. Accomodation will be provided. 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. The balance is due by the 1st December 2019. *
Are you over 18 years old? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy