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Kauri Challenge Walk 2023 Entry Form
One form per participant, please.
Complete the form below to confirm your entry into the Kauri Challenge Walk 2023. Choose between the 12km or the 21km walk and make your payment through our secure Stripe payment platform or make a bank transfer.
All funds raised come directly to the Puketi Forest Trust.
Thank you for your support!
Your details
Name
*
First name
Last name
Address
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Email address
*
Cell phone
Medical Information
If you have any current or recurrent medical information or condition, if you are on any medication or if you have any allergies or reactions to any medication that you think our search and rescue team might need to be aware of, please provide details
Enter details here...
Entry details
Walk Choice
*
12km Walk $60
21km Walk $50
12km Walk $60
21km Walk $50
The shuttle returns walkers from the walk finish at Puketi Forest Pools to their cars at Puketi Campground
Shuttle
No Shuttle
Return Shuttle $10
No Shuttle
Return Shuttle $10
Additional Donation
$0.00
$25.00
$50.00
$100.00
Other amount
$
$0.00
$25.00
$50.00
$100.00
Other
$
Total amount
$
Payment method
Stripe online payment with your credit or debit card
Direct Bank Transfer
Make deposit to account
Account Name: Puketi Forest Trust // Account Number: 03-0351-0165464-00 // Please ensure your name is shown on the payment and use reference “WALK”.
Disclaimer
DISCLAIMER:
I declare that:
1. I acknowledge that there are risks involved with the tramp and fully understand that I am responsible for my own risk and wellbeing during the tramp.
2. I acknowledge that I must take steps to ensure that I do not endanger either myself or others during the tramp.
3. Neither the organisers, nor the sponsors, nor other parties associated with the tramp shall have any responsibility for any liability, financial or otherwise whether or not by negligence, from any direct or indirect loss, injury or death which might be sustained by me or any other party directly or indirectly associated with me from my participation in this event.
4. I authorise my name and picture to be used in any broadcast, promotion or advertising or in any other way pursuant to the Privacy Act 1993.
5. I agree to comply with the rules and event instructions provided to me by the Puketi Forest Trust including any relating to postponement/cancellation or route change.
6. I consent to receiving medical treatment which may be necessary in the event of illness or injuries suffered during the course of the tramp and agree to report any injury to organisers.
7. I agree to being placed on the membership list and agree to receiving newsletters and other communications from the Puketi Forest Trust.
I agree that by entering the walk I accept the disclaimer
*
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View our privacy info www.puketi.org.nz/privacy
Click Submit to go through to payment...
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