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!
Contact Details
Full Name - Tamariki/Rangatahi
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Full Name - Whānau / Caregiver
Phone Number(s)
Email
*
example@example.com
Emergency Contact -- Name
Emergency Contact -- Phone
Kura Information
Which kura do you currently attend?
Please Select
Ashbrook School
Ōpōtiki College
Ōpōtiki Primary School
St Joseph’s School
Te Kura o Kutarere
Te Kura Mana Māori o Maraenui
Te Kura o Ōmaramutu
Te Kura o Torere
Te Kura o Waioweka
Waiōtahe Valley School
Woodlands School
Y2Hub
Te Tōtara
Other / Out of Town
University / Further Study
What year are you in at kura?
Please Select
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Year 13
University / Further Study
Left kura
Not enrolled in 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 Support
Guidance counsellor
Extra tuition
Mentoring
None
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 and Safety
Health/Medical Information - include allergies, medication, conditions
Dietary requirements
Permissions
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 consent
No, I do not consent
Other
Interests and Abilities
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
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Confidence with water activities
Not confident
1
2
3
4
Confidence
5
1 is Not confident, 5 is Confidence
Interest in Māori cultural content
Not interested
1
2
3
4
Ka rawe!
5
1 is Not interested, 5 is Ka rawe!
Faith and Religion:
Sign-off
Please sign here
Continue
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Should be Empty: