Remote Retreat Huts Application Form

Fields marked with a * are required

Emergency Contact Person

Preferred Dates

Retreat Hut Information

Survival skills

Medical Information

Current or recent medical information that we may need to be aware of in order to support you.
e.g Medication, recent trauma or ill health, chronic conditions, allergies

Names & contacts of one or two people we can contact as personal referees

TE MOATA IS A DRUG, ALCOHOL AND SMOKE FREE ENVIRONMENT

Waiver of responsibility;

I am aware of the natural hazards that are involved in in the bush-retreat experience I propose undertaking at Te Moata.

I accept full responsibility for my personal safety in the bush/retreat setting and agree to act responsibly at all times to promote my own safety.

I have shared with Te Moata all relevant personal medical/health information to support my own safety.

I agree to treat the environment and Te Moata facilities with respect.

I have read the Retreat Hut Information below and accept the parameters.