Father and Child Weekend 2019

Please select: *

Parent Name *

Parent Last Name *

Son/Daughter Name *

Son/Daughter Last Name *

Son/Daughter Name (if two)

Son/Daughter Last Name (if two)

Address *

City *

Post Code *

Phone Number *

Email Address *

Parent Ethnicity *

Parent Date of Birth * +

Son/Daughter Ethnicity *

Son/Daughter Date of Birth * +

Son/Daughter Ethnicity (if two)

Son/Daughter Date of Birth (if two) +

Emergency Contact Name - 1 *

Emergency Contact Phone Number - 1 *

Emergency Contact Name - 2 *

Emergency Contact Phone Number - 2 *

Medical Conditions and/or Dietary Requirements - if yes please specify and provide information

Sailing Experience:

Sailing Experience on Steinlager 2 or Lion New Zealand:

Yes please I would like to purchase some New Zealand Sailing Trust merchandise:

Cap $25.00

Short Sleeved T-Shirt $29.95

Long Sleeved T-Shirt $38.00

Clothing size preference

Formatted Text

Participant Signature (Parent signature if under 18 years old) *

clear

Date * +

Name *