Ōpōtiki Rangatahi Pā - General Permissions Form 2025/2026

Ōpōtiki Rangatahi Pā - General Permission Form

Kia ora whānau! This form gives permission for your rangatahi to take part in trips, events, and activities run by Ōpōtiki Rangatahi Pā throughout the year. You will still receive a trip notice before each event. Ngā mihi!
- Full Name - Tamariki/Rangatahi
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
  Date
- Full Name - Whānau / Caregiver
- Phone Number(s)
- Email*
  example@example.com
- Emergency Contact -- Name
- Emergency Contact -- Phone
- Which kura do you currently attend?
- What year are you in at kura?
- What's challenging for you at kura right now?
  eg. learning, friendships, subjects, anger issues etc
- Additional Support: Do you get support at kura?
  
  Learning SupportGuidance counsellorExtra tuitionMentoringNone
- What extra supports would you want in place for your young person at kura or offered through our programmes?
  Dream big! Occupational therapist, dyslexia support, irlens glasses, emotional regulation support, addiction support, mentoring, tutoring etc
- Health/Medical Information - include allergies, medication, conditions
- Dietary requirements
- Permissions for Ōpōtiki Rangatahi Pā events and trips:
  
  I give permission for my rangatahi to take part in Ōpōtiki Rangatahi Pā trips and events.I give permission for my rangatahi to be transported in the ORP van, staff vehicles, or hired transport.I understand each trip will have its own information sheet.
- I give permission for photos/videos of my young person to be used for ŌRP kaupapa (social media, website, reports)*
  
  Yes, I consentNo, I do not consentOther
- What are your young person's main interests or hobbies?
  
  Arts and Creativity (drawing, crafting, music, performing arts)Sports and Outdoor Activities (waka ama, rugby, skateboarding, horse riding, running, hunting, outdoor adventures)Cultural and Community (Māori arts, kapa haka, te reo Māori, volunteering, environmental care, conservation projects)Learning and Technology (Science experiments, STEM activities, coding, robotics, AI, reading, writing, storytelling, board games, escape rooms)Other
- Sports details: Which sports or outdoor activities does your rangatahi enjoy?
- Arts and Creativity: Which arts of creative activities do they enjoy?
- Cultural Activities: Which cultural activities do they most enjoy?
- Learning and Technology: Which learning and technology activities do they enjoy the most?
- Other: What other activities are they interested in?
- Days available for activities
  
  MondayTuesdayWednesdayThursdayFridaySaturdaySunday
- Confidence with water activities
  
  1
  
  2
  
  3
  
  4
  
  5
  
  1 is Not confident, 5 is Confidence
- Interest in Māori cultural content
  
  1
  
  2
  
  3
  
  4
  
  5
  
  1 is Not interested, 5 is Ka rawe!
- Faith and Religion:
- Please sign here
- Should be Empty:

Ōpōtiki Rangatahi Pā - General Permission Form