Parent Permission Form | Download here
Kiwiana Tours Permission Form Updated Jan 2023
Parents, please fill in the following form to give permission for your child to travel with Kiwiana Tours
Trip Name ___________________________________________________Trip Date_______________________
Student Name (First) _____________________________(Last)________________________________________
Country__________________Student Email_________________________Student Mobile__________________
Gender ________________________________Date of Birth ______/______/_______ (Min age 14years)
food, medical, emotional health, allergies,___________________________________________________
Emergency Contact________________________Name of School attending in NZ____________________________
Natural Parents contact Phone____________________Email______________________________________
Natural Parent Full Name_______________________________________________________________
I agree and give permission for my child to take part in travel programs that Kiwiana Tours offers & any of the following activities marked X.
Acknowledgment of Risk
I understand that there are risks associated while traveling 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.
Natural Parent Signature _______________________________ Date signed _____/_____/______
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 |
Kiwiana Tours 2009 Limited | 42 Couldrey Cresent, Red Beach Auckland City 0932 New Zealand.
www.kiwianatours.com | Tour Leaders 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.
Student, I have read all the above and agree to follow the rules and instructions of the Kiwiana tour leader while on tour.
Student Signature:
________________________________________________________________________________