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2018 Manaaki Hauora Registration Form
Te Whare Wānanga o Te Waipounamu
An ICHC Approved Training and Accreditation Programme for Chaplains Working with Māori
All areas are to be completed to finalise enrolment but does not guarantee admission to the programme.
We look forward to hearing from you. Remember you are welcome to phone or email with questions at any time.
Kaingakautia te mōhiotanga
Rangahaua te māramatanga
Kia ea rawa ai-ko wai āi – ko wai rā koe?
I ahu mai i whea?
Ma tēna e ora ai te tinana
Ka hihiko nei te hinengaro
Ko te wairua e whakaāio noa atu
He kākano koe i ruia e Rangiātea.
Desire knowledge and seek understanding
of who you are and from whence you came.
From this you will heal the body,
Activate the mind and calm the soul.
You are a seed sown from the
Ancestral homeland of Rangiātea.
You will never be lost.
2018 Calendar
(Many may arrive on the Monday,
however, the course actually starts 10am on the Tuesday)
**Please note these dates may have changed from previously advertised**
Module One:Tuesday 20th - Friday 23rd February 2018
Module Two:Tuesday 17th - Friday 20th April 2018
Module Three:Tuesday 19th - Friday 22nd June 2018
Module Four:Tuesday 21st - Friday 24th August 2018
Maximum 12 people - pre-enrolment essential
Please use one entry per person thanks.
Personal Details
Persons name
First name
Last name
Email address
Home phone
Cell phone
Other phone
Persons address
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Date of Birth
Place of birth
Gender
Male
Female
Allergies/ Dietary
Medical
Please list any special dietry requirements or medical conditions we should be aware of should you need urgent care.
Emergency Contact name, relationship and Contact Number
Drivers licence
Passport
Rohe/ Archdeaconry
Local church
Local Church Leader name and contact details
Let us know if anyone might need picking up from the airport, train or bus depot (Yes/ No)
If Yes please put details of arrival so we can organise a shuttle pick-up.
Do you have a first aid certificate? Please add number and expiry date if yes
This is to assist us with our Health and Safety requirements and duty of care - especially when we are on field trips.
Authority to use image (Yes/ No)
I give permission to the Anglican Maori Diocese of Te Waipounamu or Te Whare Wānanga o Te Waipounamu to use my image in photos for the purposes of reporting or marketing of the activities including but not limited to publications, newsletters, and websites of the Anglican Maori Diocese of Te Waipounamu or Te Whare Wānanga o Te Waipounamu.
Note: You are required to fill in the Police Check form because there are certain conditions and justice issues that can affect your suitability for taking the course due to the nature of the field you will be training in.
Brief Description of Ministry
Chaplaincy Work History
Ministry Training
Why do you want to do this course?
How will it benefit your mahi/ministry?
Practical Ministry skills
Formal/ Informal Qualifications and Awards
Life Experience
Work Experience
Checklist
Please ensure that all documentation and information is provided to ensure a smooth process of your enrolment. Have you scanned and attached these documents with your enrolment form? (or post, or bring on day one)
Certified copy of your current Passport
Certified copy of your current Drivers Licence
Certified copy of your Birth Certificate
Have you completed the Police Check Form attached?
If you have had a name change from that on your Birth Certificate, please provide a legal document advocating that name change (i.e Marriage Certificate, Passport)
It is important that we create a safe learning environment. This means we need historical information about each student. This information is treated as confidential under the Privacy Act 1993.
Te Whare Wānanga o Te Waipounamu collects and stores information from this form to comply with the requirements of the St Johns College Trust (funding and student statistical returns).
In addition, when required by law, Te Whare Wānanga may be obliged to release information to Government agencies such as the New Zealand Police, Department of Justice, Department of Work and Income, and the Accident Rehabilitation Compensation Corporation
In accepting this enrolment form you authorise such disclosure on the understanding that the Wānanga will observe the general conditions governing the release of information, as set out in the Privacy Act 1993. You may see any information held about you.
He Waka Eke Noa
Everyone in one canoe with no exception
Many Thanks
Please check the highlighted fields
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