Pilot programme 2019 APPLICATION form

Our Onehunga programme is now full. Please fill in the form below to apply for a place in our Albany programme, starting 11th February and running for six weeks on Monday afternoons from 4-6pm. Dates and more info can be found here.

Important: Before filling out this form, please follow this link to read our Parent and Student Agreements on our Programme Attendance Terms and Conditions page. We are only able to accept registrations from applicants who agree to these terms.

Name of student *
Name of student
If yes, please provide details including the symptoms and suggested management of any allergies or known health problems that could arise.
If yes, please provide details of how this might impact the student during class and how we can best support the student during our classes.
If yes, please provide details of how this might impact the student during class and how we can best support the student during our classes.
If yes, please provide details.
Name of parent/legal guardian *
Name of parent/legal guardian
Name of emergency contact person (must be different from name above) *
Name of emergency contact person (must be different from name above)
Please tick to confirm that both parent/legal guardian and student have read and agree to the Initialize NZ Programme Attendance Terms and Conditions (see link at top of page): *
Accepting this registration is at the discretion of Initialize NZ and is subject to student numbers.