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Enrolment Form

for Rainbow Valley Farm

Permaculture Design Course

5-20 February 2010 or 26 March-9 April 2010

 

Please complete this form and send/email to address below.  Deposit NZ$500 required to confirm booking.

 

Name:___________________________________Male/Female:__________________

 

Address: ______________________________________________________________

 

______________________________________Date of Birth: ____________________

 

Home Phone: ______________________          Mobile: _________________________

 

Email:________________________________________________________________

 

Course date: __________________________________________________________

 

Course Fee:  We are offering a range of accommodation options on and off Rainbow Valley Farm in close proximity to the farm.  Please select your choice.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Early bird fee:  $100 discount if paid in full before 30 November for Feb course or 30 December for March course.

 

NZ$500 deposit is required to secure a place (non-refundable except if cancelled 3 weeks before start of course).

 

Food Preference:          Most of the food on the course is organic.

 

Meat:____________________   Vegetarian___________________   No Preference:______________________

If you have special dietary requirements you may need to bring supplies with you.

 

Student Profile:

The following questions are helpful to the tutors and course leaders.

 

1. Brief details of your background, where you come from, skills and what you’ve been involved in.

 

 

2.      Why did you decide to do the Permaculture Design Course? What do you hope to get out of          it?

 

 

3. How did you hear about this course?

 

The following questions will enable us to provide the best care and safety for our students.  This information will be kept confidential at all times.

4. Please indicate your general state of health:     Fair               Good           Excellent

5. Are there any health issues we need to be aware of (e.g. alleries, asthma, recurring injuries etc)

 

6.      Are you on any medication?  If so please give details.

 

I understand that:

 

A) A deposit of $500 secures my place on the course. (Please send a cheque or email us for our bank details for direct crediting.)

B) If I cancel the deposit is non-refundable except if cancelled 3 weeks before the course starts.

C) The balance is due at the commencement of the course (unless taking early bird option).

 

Signature: ………………………………….. Date:…………………………………….

On receipt of this form and your $500 deposit we will send you more information about the course.

 

Rainbow Valley Farm, 588 Matakana Valley Road, R.D. 5, Warkworth 0985, New Zealand, Tel. 0064 9 422 7432