Wild Nature Crucible For Women
Please take your time to complete the registration form
Participant Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Region / State / Province
Postal / Zip Code
E-mail
*
example@example.com
Mobile Number
*
Emergency Phone Number
*
Name of Emergency Contact
*
What are you hoping to experience during the Wild Nature Crucible for Women?
*
Please share your comfort level in nature
*
Do you feel comfortable with hiking up to 2km on and off trail with a backpack weighing up to 20kg?
*
Yes no problem
Yes with some breaks
Not comfortably
Not at all
Please share your camping experience
*
I feel confident to set up a tent on my own and my bedding including inflatable mattress
I don't have any experience but feel confident I can learn with support
I feel completely out of my element navigating camping and will need support
Would you like to hire any of the following?
*
A tent
A camp mattress
A sleeping bag
A backpack
None of the above as I have all of those items
Please share any dietary requirements below
Is there anything else you think would be useful to share, that would help us best support you? Emotional, physical or other.
*
What are your transport options to get to the Craigieburn Environmental Centre?
*
I would like a ride from Christchurch airport
I have a car but cannot offer others a ride
I have a car and can offer others a ride from Christchurch
I need a ride from Christchurch central bus station
Other
If you selected 'other', please share here. Or, if you are driving and have room to offer others a ride, please share where you are driving from.
For our marketing research would you please share how you heard about this program?
*
Submit
Should be Empty: