Permission Form up dated May 2018   Tour Name ____________________________________ Date of Tour___________________ Student Full Name ____________________________________________Nationality_____________________ ☐Male ☐Female                  Date of Birth____/____/_____ (Min age 14years) Student Phone: _________________________ Email ______________________________________________ Any special food requirements, allergies or medical conditions. __________________________________________________________________________________________________ NZ SCHOOL information and approval Name of School ____________________________________________________Phone___________________ Name of school Emergency Contact _______________________ Approved sign: ________________________ EMERGENCY CONTACT DETAILS Homestay Name: ___________________________________________________________________________ Address NZ ________________________________________________________________________________ PH: _________________ MOB: _________________ Homestay Signature _____________________________ Parent Consent: I agree and give permission for my child to take part in travel programs that Kiwiana Tours 2009 Limited offers. Tick any boxes to give permission for my child to take part in any of the follow activities.  
Rotorua, Taupo & Waitomo Bay of Islands Coromandel All or other trips
White Water Rafting Ocean Kayaking Ocean Kayaking Surfing - guided (Summer)
Bungy Jumping Swim with dolphins Bush walking Skiing - boarding (Winter)
Zorb   Quad Bikes Sailing or boating  Horse Riding Horse Riding
Gondola & Luge Skydive Boogie Boarding Rollers Skating
Boat (Jet Boat / Sail) Parasailing Surfing (not guided) Ice Skating
Skydive Helicopter Zip lining
Black Water Rafting Paddle Boarding Swimming in a Lake   Spa   Pool
Any extreme Activity offered                               Tick any of the above for a South Island trip
  Acknowledgement of Risk I understand that there are risks associated while travelling and with other activity operators and these risks cannot be completely eliminated. Kiwiana Risk assessment is available for your reading from our office. I know I can ask any questions from Kiwiana Tours about the travel and activities my child may be involved in, to gain a better understanding of the risks involved. I understand that Kiwiana Tours does not accept responsibility for loss or damage to personal property and that it is my responsibility to check my own insurance policy. Sign by Natural Parent or Guardian of the child participant.   Parent Signature ________________________________________ Date _____/_____/______ Natural Parent Full Name ________________________________________________________ Kiwiana Tours 2009 Limited. 29 Princes Street, Auckland City 1140, New Zealand. PH Catherine 02102703611 / Dave 0272030403 Kiwiana Tours abide by the NZQA Code of Practice for the Pastoral Care of International Students and is Qualmark certified. This trip is run as a school trip and School rules apply, no drinking or smoking is permitted on this tour, even if you are 18 years or more. Students: I have read all the above and agree, SIGN:_____________________________________________