Register — Primal Getaway

Get registered.

Hold on a minute!

Before you give us all your details, make sure you read all the terms, conditions and rules of Primal Getaway. Just click the link below

Terms and conditions.

By registering for Primal Getaway you are agreeing to the terms and conditions.

Name *

Name

First Name

Last Name

Email Address *

Gender *

Female

Male

Mobile Phone *

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primal/Church *

Medical / Allergies *

Dietary Restrictions *

None

Vegetarian

Vegan

Gluten-free

Dairy-free

Are you a confident swimmer? *

Able to swim over 50 metres

Emergency Contact *

Emergency Contact

First Name

Last Name

Emergency Contact Phone *

Relationship to you *

Campers Date of Birth *

Campers Date of Birth

YYYY

Caregiver Signature

If the camper is under the age of 18. We need written proof that you have authority to allow them to come to Primal Getaway. Please take a photo of a form of identification for yourself and another photo of you giving written consent. Please include the campers full name, your full name, Primal Getaway and your signature. Then please send a photo of your consent to getaway@c3.org.nz.

Caregiver Full Name *

Caregiver Full Name

First Name

Last Name

Terms & Conditions *

By registering for Primal Getaway you are agreeing to the terms and conditions.

I agree

PRICES.

Current Price - $219
You can pay a deposit of $50 to lock in the current registration price.

Payment.

BANK DEPOSIT

Primal Youth Trust
03-0195-0466555-000

Reference: Camper Initial & Surname

CHEQUES

Please send cheques to:
Primal Youth Trust
PO Box 11406
Ellerslie
Auckland, 1051

PAYPAL