PERSONAL INFORMATION *

First Name

Last Name

Phone *

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EMERGENCY CONTACT INFORMATION *

First Name

Last Name

Phone *

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PROGRAMMES SELECTION *

Select the programme(s) you are interested in

Budgeting Appointments/Financial Mentoring

Financial Literacy Workshops

Parenting Programme

Choice (Social & Emotional Well-being Programme)

Learner Driver Licence - 2 Day Course

Te Reo Maori Classes

Social & Craft Group

Maara Kai Gardening Workshops

Te Whare Ora (Healthy Homes) Workshops

Consent and Agreement for Te Puna Waiora/Desert Spring Programs *

DISCLOSURE STATEMENT: By submitting this form, you consent to the collection and use of your personal information for the purposes of program registration and management. Your information will be kept confidential by Te Puna Waiora Desert Spring Ministries Trust and will only be accessible by their authorized personnel. WAIVER STATEMENT: I acknowledge that participating in Te Puna Waiora programs may involve certain risks. I hereby release and discharge Te Puna Waiora, its officers, employees, and agents from any and all liability for personal injury, property damage, or wrongful death that may occur during my participation in these programs. TERMS AND CONDITIONS By registering for one or more Te Puna Waiora programs, you agree to adhere to the following terms and conditions: + Follow all instructions and guidelines provided by Te Puna Waiora. + Respect the privacy and confidentiality of all individuals you encounter. + Report any concerns or incidents to a program supervisor immediately. + Commit to the agreed-upon schedule and notify in advance if you are unable to attend. + Failure to comply with these terms may result in the termination of your participation in the programs.

I agree to the Disclosure, Waiver, and Terms & Conditions above.