Register for a Course

298b Flaxton Road, Rangiora, NZ

Interested in a course? Contact us below!

Student Name

Name of person completing this form

Phone

Last place of employment

Last place of education

Training

Date of Birth

Gender

Ethnicity

Area you live in

How did you first hear out about YDOT?

Have you attended YDOT courses previously

Do you have transport arrangements that will ensure you can arrive at course for the scheduled times and dates?

Are there any other commitments that may prevent you from arriving to course at any stage?

Any medical conditions we should know about?

Any learning disabilities we should know about?

Please note anything else (eg physical limitations that may impact on your ability to complete the course )

Contact Name

Contact Phone Number

Relationship to student

Please note the name of Youth Service or Youth worker you are currently connected with

Email contact for support person/referrer

Support Person's Phone Number

Any further comments:

Thanks for completing details,

we will be in touch shortly!