ADDITIONAL GROUP MEMBERS? (Overseas visitors please include your passport number and your nationality.)
Name:
Name:
Name:
Name:
Name:
Name:
Name:
Name:
Name:
Address/Passport No./Nationality:
Address/Passport No./Nationality:
Address/Passport No./Nationality:
Address/Passport No./Nationality:
Address/Passport No./Nationality:
Address/Passport No./Nationality:
Address/Passport No./Nationality:
Address/Passport No./Nationality:
Address/Passport No./Nationality:
Phone:
Phone:
Phone:
Phone:
Phone:
Phone:
Phone:
Phone:
Phone:
Medical Conditions & Medication:
Medical Conditions & Medication:
Medical Conditions & Medication:
Medical Conditions & Medication:
Medical Conditions & Medication:
Medical Conditions & Medication:
Medical Conditions & Medication:
Medical Conditions & Medication:
Medical Conditions & Medication:
ADDITIONAL GROUP MEMBERS
New Zealand Outdoors Intentions Form
Safety is your responsibility so tell someone, it could save your life | www.adventuresmart.org.nz
This additional information sheet is for Outdoors Users to record additional group members taking part in their
trip. It must be used in conjunction with the full Outdoors Intention form and not on its own.
EXPECTED DATE OF RETURN
OUTDOOR USER/LEADER NAME
EXPECTED TIME
START DATE
D D M M Y Y
D D M M Y Y
/ /
/ /
:
AM
PM
8
7
9
10
11
12
13
14
15
vadavadvadv
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome