SignUp | Taranaki Retreat

👋 Thank you for joining our Team – we are stoked that you are here.

Your name: *

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Last

Your home address *

Your email address *

Confirm Email

Your mobile number *

Your date of birth *

Your gender: *

Your pronouns:

E.g., he/him, she/her, they/them, etc.

Are you part of the rainbow / LGBTQ+ community?

Do you identify as neurodivergent?

Do you think of yourself as disabled (or as having a disability?)

Please let us know of an emergency contact / next of kin, starting with their name: *

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Last

What's their connection to you? *

Their address? *

And their contact number? *

What do you wish to achieve through your involvement with Taranaki Retreat? *

Any other goals?

What skills/experience do you bring to this role? *

For roughly how many hours per month would you be available? *

Do you have any health, mobility, or other accessibility needs you'd like us to be aware of? *

Enter N/A if not applicable 🙂

Please enter details for a personal referee (not a whānau member), starting with their name: *

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Last

What's their connection to you? *

Their contact details (phone number and/or email address)? *

Anything else you'd like to tell us?

Finally, please add a selfie / photo of yourself here, for using on our system: *

Click or drag a file to this area to upload.