PCKC Membership Form Sept 2024 to Aug 2025
All paddlers are required to be financial members of PCKC prior to competing in any races such as Regional, National and International events. PCKC gives new paddlers the opportunity to paddle for no more than three weeks before a membership form is required to be completed and fees paid.
I/we are: -
Current Whānau
New Whānau
Your Name
First Name
Last Name
Gender
F
M
Your Date of Birth
-
Day
-
Month
Year
Date
Address
Street Address
Street Address Line 2
Suburb
Town/City
Postcode
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Ethnicity Information required by Nga Kaihoe o Aotearoa (NKOA)
*
NZ European
Māori
Samoan
Cook Islands Maori
Tongan
Niuean
Chinese
Indian
Other
Select Iwi
Kāti Māmoe
Maungaharuru Tangitū
Moriori
Muaūpoko
Ngā Pōtiki ā Tamapahore
Ngā Rauru
Ngā Ruahine
Ngāi Tahu / Kāi Tahu
Ngāi Tai (Tauranga Moana/Mātaatua)
Ngāi Tai ki Tāmaki
Ngāi Takoto
Ngāi Tāmanuhiri
Ngāi Te Ohuake (Rangitīkei)
Ngāi Te Rangi
Ngāpuhi
Ngāpuhi ki Whaingaroa-Ngāti Kahu ki Whaingaroa
Ngāti Apa (Rangitīkei)
Ngāti Apa ki Te Rā Tō
Ngāti Awa
Ngāti Hako
Ngāti Haua (Taumarunui)
Ngāti Haua (Waikato)
Ngāti Hauiti (Rangitīkei)
Ngāti Hei
Ngāti Hīkairo
Ngāti Hine (Te Tai Tokerau)
Ngāti Hineuru
Ngāti Kahu
Ngāti Kahungunu ki Heretaunga
Ngāti Kahungunu ki Tamakinui a Rua
Ngāti Kahungunu ki Tamatea
Ngāti Kahungunu ki Te Wairoa
Ngāti Kahungunu ki Te Whanganui-a-Orotu
Ngāti Kahungunu ki Wairarapa
Ngāti Kauwhata
Ngāti Kearoa / Ngāti Tuarā
Ngāti Koata
Ngāti Korokī Kahukura
Ngāti Kuia
Ngāti Kurī
Ngāti Mākino
Ngāti Manawa
Ngāti Maniapoto
Ngāti Manuhiri
Ngāti Maru (Hauraki)
Ngāti Maru (Taranaki)
Ngāti Mutunga (Taranaki)
Ngāti Mutunga (Wharekauri/Chatham Islands)
Ngāti Pāhauwera
Ngāti Paoa
Ngāti Pikiao (Te Arawa)
Ngāti Porou
Ngāti Porou ki Harataunga ki Mataora
Ngāti Pūkenga ki Waiau
Ngāti Pūkenga
Ngāti Rāhiri Tumutumu
Ngāti Rākaipaaka
Ngāti Rangi (Ruapehu, Whanganui)
Ngāti Ranginui
Ngāti Rangiteaorere (Te Arawa)
Ngāti Rangitihi (Te Arawa)
Ngāti Rangiwewehi (Te Arawa)
Ngāti Rārua
Ngāti Raukawa (Horowhenua/Manawatū)
Ngāti Rēhua
Ngāti Rongomai (Te Arawa)/ Ngāti Pūkenga
Ngāti Ruanui
Ngāti Ruapani ki Waikaremoana
Ngāti Tahu-Ngāti Whaoa (Te Arawa)
Ngāti Tama (Taranaki)
Ngāti Tama (Te Waipounamu/South Island)
Ngāti Tama ki Te Upoko o Te Ika (Te Whanganui-a-Tara/Wellington)
Ngāti Tamakōpiri (Rangitīkei)
Ngāti Tamaoho
Ngāti Tamaterā
Ngāti Tara Tokanui
Ngāti Tarāwhai (Te Arawa)
Ngāti Te Ata
Ngāti Tiipa
Ngāti Toarangatira (Te Waipounamu/South Island)
Ngāti Toarangatira (Te Whanganui-a-Tara/Wellington)
Ngāti Tukorehe
Ngāti Tūwharetoa (ki Taupō)
Ngāti Tūwharetoa ki Kawerau
Ngāti Wai
Ngāti Whakaue (Te Arawa)
Ngāti Whanaunga
Ngāti Whare
Ngāti Whātua (not Ōrākei or Kaipara)
Ngāti Whātua o Kaipara
Ngāti Whātua o Ōrākei
Ngāti Whitikaupeka (Rangitīkei)
Pakakohi
Patukirikiri
Rangitāne (Manawatū)
Rangitāne (Te Matau-a-Māui/Hawke's Bay/Wairarapa)
Rangitāne (Te Waipounamu/South Island)
Rangitāne o Tamaki nui ā Rua
Raukawa (Waikato)
Rereahu
Rongomaiwahine (Te Māhia)
Rongowhakaata
Tamahaki (Ruapehu, Waimarino)
Tamakana (Ruapehu, Waimarino)
Tangāhoe
Tapuika (Te Arawa)
Taranaki
Te Aitanga ā Hauiti
Te Aitanga-a-Māhaki
Te Ākitai-Waiohua
Te Ati Haunui-a-Pāpārangi
Te Atiawa (Taranaki)
Te Atiawa (Te Waipounamu/South Island)
Te Atiawa (Te Whanganui-a-Tara/Wellington)
Te Atiawa ki Whakarongotai
Te Aupōuri
Te Hika o Pāpāuma
Te Kawerau ā Maki
Te Paatu
Te Rarawa
Te Roroa
Te Upokorehe
Te Uri-o-Hau
Te Whānau-ā-Apanui
Tūhoe
Tūhourangi (Te Arawa)
Uenuku (Ruapehu, Waimarino)
Uenuku-Kōpako (Te Arawa)
Waikato
Waitaha (Te Arawa)
Waitaha (Te Waipounamu/South Island)
Whakatōhea
Other (Iwi and Region, e.g Taranaki, Waikato)
If more than one Iwi please write in box below
Please Include other eg: English, Irish
I agree to photos or videos of myself or my child/children being used on PCKC's website for promotional or fundraising purposes by PCKC
*
Yes
No
I consider myself / my whānau (son, daughter, mokopuna) to be physically fit and capable of full participation and agree to notify the crew coach and/or manager of any changes to the medical information provided
*
Yes
No
In the event of injury I give permission to the team managers/coaches appointed by PCKC to obtain emergency medical treatment for myself / my son/ my daughter/ my mokopuna
*
Yes
No
Are you including Whānau in this membership?
*
Yes
No
Whanau
2nd Name
First Name
Last Name
Gender
F
M
2nd Date of Birth
-
Day
-
Month
Year
Date
3rd Name
First Name
Last Name
Gender
F
M
3rd Date of Birth
-
Day
-
Month
Year
Date
4th Name
First Name
Last Name
Gender
F
M
4th Date of Birth
-
Day
-
Month
Year
Date
Do you require more whānau in this membership?
Yes
No
5th Name
First Name
Last Name
Gender
F
M
5th Date of Birth
-
Day
-
Month
Year
Date
6th Name
First Name
Last Name
Gender
F
M
6th Date of Birth
-
Day
-
Month
Year
Date
7th Name
First Name
Last Name
Gender
F
M
7th Date of Birth
-
Day
-
Month
Year
Date
ALL Water Safety Information Required - assessment in your team will be processed
*
Yes
No
In process
Are you (or other wh
ā
nau members that paddle) confident in the water?
Comfortable with a lifejacket if you can't swim?
Confident in the ocean and can swim?
Familiar with risk control if waka is swamped or capsizes?
Have a current lifesaving certificate?
Have a current First Aid certificate?
Have you provided up to date Medical information
*
Yes
No
Medical Information
In case of emergency and as part of PCKC's responsibility to health and safety, ALL members are required to complete this medical information form as accurately as possible. Details will be held securely with access restricted to authorised officers only
Emergency Contact
First Name
Last Name
Emergency Phone
-
Area Code
Phone Number
Are you and/or whānau members taking any regular medication?
Yes
No
Please name or list medication
Do you / any of your whānau listed as paddlers have allergies/conditions that we need to be aware of?
Yes
No
What are the allergies/conditions?
Do you / any of your whānau listed as paddlers suffer from any long-term illness, physical disability, impairment condition or injury?
Yes
No
What do you / they suffer from?
Have you / any of your whānau listed as paddlers paddled for another waka ama club, kayak club or surf club
Yes
No
If yes, which club was it?
Would you/any of your whānau be interested in coaching, being a team manager, club officer or committee member?
Yes
No
PCKC Club Membership and NKOA fee been renewed? Due September each year.
Yes
No
Membership Type and Fees
NKOA to be paid by 31 Oct, PCKC and Hoe Tonga Fee's due by 30 Nov. Please NOTE that NKOA and Hoe Tonga fees are only payable if you paddle.
Please select age/s or whanau membership and under per person (pp) you can add in number of memberships
prev
next
( X )
Tick to confirm for Midget Paddler
$
25.00
NZD
6 to 10 years of Age (inclusive)
Fees
per person (pp)
Price
PCKC Membership
$
25.00
NZD
Include more children if required
$
5.00
NZD
NKOA Fee
$
5.00
NZD
Photo ID Card
$
5.00
NZD
Hoe Tonga Fee
$
4.00
NZD
Item subtotal:
$
0.00
NZD
Tick to confirm for Intermediate Paddler
$
25.00
NZD
11 to 13 years of age (inclusive)
Fees
per person (pp)
Price
PCKC Membership
$
25.00
NZD
Include more children if required
$
5.00
NZD
NKOA Fee
$
5.00
NZD
Photo ID
$
5.00
NZD
Hoe Tonga Fee
$
4.00
NZD
Item subtotal:
$
0.00
NZD
Tick to confirm for J16 Paddler
$
50.00
NZD
14 to 16 years of age (inclusive)
Fees
per person (pp)
Price
PCKC Membership
$
50.00
NZD
NKOA
$
12.00
NZD
Photo ID Card
$
5.00
NZD
Hoe Tonga Fee
$
8.00
NZD
Item subtotal:
$
0.00
NZD
Tick to confirm for J19 Paddler
$
50.00
NZD
17 to 19 years of age (inclusive)
Fees
per person (pp)
Price
PCKC Membership
$
50.00
NZD
NKOA Fee
$
12.00
NZD
Photo ID Card
$
5.00
NZD
Hoe Tonga Fee
$
8.00
NZD
Item subtotal:
$
0.00
NZD
Tick to confirm for Senior Paddler
$
90.00
NZD
Over 19 Years of Age
Fees
per person (pp)
Price
PCKC Membership
$
90.00
NZD
NKOA Fee
$
15.00
NZD
Photo ID Card
$
5.00
NZD
Hoe Tonga Fee
$
15.00
NZD
Item subtotal:
$
0.00
NZD
Tick to confirm for Golden Master Paddler
$
25.00
NZD
60 years and over
Fees
per person (pp)
Price
PCKC Membership
$
25.00
NZD
NKOA Fee
$
15.00
NZD
Photo ID Card
$
5.00
NZD
Hoe Tonga Fee
$
15.00
NZD
Item subtotal:
$
0.00
NZD
Tick to confirm for Whānau Membership
$
150.00
NZD
Two parents or caregivers and up to four children from the same whānau
Fees
Select 1 for Whānau and per person their fees.
Price
Whānau (per Whānau) select 1
$
150.00
NZD
Select NKOA Fee for Midget or Inty
$
5.00
NZD
Select NKOA Fee for Junior
$
12.00
NZD
Select NKOA Fee for Senior
$
15.00
NZD
Photo ID Card
$
5.00
NZD
Hoe Tonga Fee Junior under J19
$
10.00
NZD
Hoe Tonga Fee J19 up
$
15.00
NZD
Item subtotal:
$
0.00
NZD
Tick to confirm if Associate Paddler
$
15.00
NZD
May be available to person or groups whom the club committee deems unlikely to enjoy the full benefits of club membership. Associate membership does not afford voting rights at meetings
Fees
per person (pp)
Price
PCKC Membership
$
15.00
NZD
NKOA Midget Inty
$
5.00
NZD
NKOA Junior under J19
$
12.00
NZD
NKOA Senior J19 up
$
15.00
NZD
Photo ID Card
$
5.00
NZD
Hoe Tonga Fee under J19
$
10.00
NZD
Hoe Tonga Fee over J19
$
15.00
NZD
Hoe Tonga Fee under 5
$
0.00
NZD
Item subtotal:
$
0.00
NZD
Total
$
0.00
NZD
PCKC account: PCKC membership Fee: 03-05470914818-00 NKOA and/or Hoe Tonga Fee: 03-0547-0914818-01
Please type in reference being used with your payments
All paddlers are required to have a membership number and an ID Card to produce at events. a photo and proof of ID such as a copy of your passport, birth or marriage certificate, or drivers licence. You can upload or email poriruacanoekayakclub@gmail.com
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