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  • Thanks for applying for the Youth Environmental Leadership course, held by Kaipatiki Project. 

    This programme runs between Monday 16 October - Friday 20 October. 

    After the progrramme, we are asking leaders to help plan and run a community event aimed at improving their environment. We will work with you during the programme and afterwards to run an event before Christmas. 

    We're really excited to work with future leaders, who'll create change in their communities. Please fill out the questions below so we can learn a little about you.



  • 1A

    First name

  • 1B


  • 1C


  • 1D

    What year are you in at school?

  • 1E

    Street number and street name

  • 1F


  • 1G

    What's your mobile number if you have one?

  • 1H

    Emergency contact person (parent / guardian)

  • 1I

    Mobile phone number of emergency contact person

  • 1K


  • 1L

    How will you get to and from Kaipatiki Project at 17 Lauderdale Road, Birkdale? (Walk, bike, catch a bus, get a ride with a parent etc)

  • 1M

    Do you own a bike and would you be able to bring it for a day?

  • 1N

    Any dietry requirements? (Vegetarian, gluten free etc)

  • 1O

    Do you have any health issues? (e.g  allergies, asthma, diabetes, injury etc) What medication or treatment are you using?

  • 1P

    Do you have any physical disability that you might want us to be aware of? (e.g poor sight, impaired hearing etc)

  • 1Q

    What are your hobbies?

  • 1R

    Tell us about any volunteering that you've been involved with.

  • 1S

    What are you hoping to learn through being involved in the Youth Environmental Leadership programme?

  • 1T

    Is there anything that would stop you attending the workshops between 8.30am - 4pm? (e.g Doctors appointments, sports practice, family committments)

  • 1U

    Is there anything else you'd like to tell us?