Do you work in a Volunteer capacity? *

Yes

No

Are you taking any prescribed medication currently? *

Yes

No

Are you under the direction of a mental health professional, e.g. psychologist, psychiatrist or counsellor? *

Yes

No

If a non NZ citizen, do you have travel insurance - covering personal belongings and health?

Yes

No

Are you bringing children with you? *

Yes

No

Do you want your children to be debriefed?

Yes

No

If not, please provide the name of the babysitter / childminder who will be coming with you to care for the children:

First Name

Last Name