Te Hikoi O Nga Tane Registration - MORRINSVILLE
Held weekly on a Thursday from 7th February 2019
At Morrinsville Community House, 43 Canada Street, Morrinsville

Facilitator Contact: Mihaka Hohua 027 271 3039
Pai Ake Solutions, 07 853 2533 or 0800 PAI AKE [0800 724 253]

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Name [First, Last] *
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Date of Birth *
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Address *
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Ethnicity - Tribal Affiliations *
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Emergency Contact [Name & Phone Number]
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Mobile number for communication purposes only.
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Consent
I wish to take part in the Te Hikoi O Nga Tane – The Men’s Walk programme. I consent for this information and a record of my group attendance to be held at Pai Ake Solutions Ltd office and to be used to record attendance statistics. I understand that the expectation is that I attend one sessions for 2 hours a week, for 15 weeks. I will endeavour to contact the facilitator if I am unable to attend any session. I acknowledge that if I do not attend 2 consecutive sessions without any communication to the facilitator, I may be withdrawn from the programme.
I agree to the consent above. *
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