BE weekend application form

Please fill in all fields where ever possible. Any details requested and not provided will delay processing of Beginning Experience NZ Weekend Application. (*) - implies required data.

Surname or Family name:(*)

Invalid Input

Given or First names:(*)

Invalid Input

Postal Address:(*)

Invalid Input

Include post code

Email Address:(*)

Invalid Input

Telephone Number (area code - number):

Invalid Input

Mobile Phone number:(*)

Invalid Input

Date of Birth(*)

Invalid Input

Gender:(*)

Invalid Input

Religious Affiliation:(*)

Invalid Input

Current Status(*)

Invalid Input

First Marriage?:

Invalid Input

If No:

Invalid Input

If not first marriage please give details of the length of an other marriages and how they ended.

How long were you in the partnership?

Invalid Input

How long have you been single again

Invalid Input

Number of children:

Invalid Input

Please provide number of children and what ages. One child per line.

Current Therapy or Counselling?

Invalid Input

Please indicate if you are currently involved an any kind of professional Counselling or Therapy.

If YES, we most strongly recommend that you discuss taking part in a Beginning Experience Weekend with your Counseller/ Therapist. Please take this form and the Beginning Experience Weekend Brochure with you, and let your professional know that they may call on the advertising material for further information or clarification.)

How did you hear about Beginning Experience?

Invalid Input

Why interested?

Invalid Input

Please comment on why you are interested in taking part in a Beginning Experience Weekend.

Physical / Medical conditions:

Invalid Input

Do you have any physical/medical conditions, special dietary or other spical needs that we, as organisers of a live-in Weekend, should be aware of (e.g do you need medication at set times?)

A member of our Local Team will contact you to discuss your application in more detail.

Permission to make use of personal information:

By selecting YES below - you agree as follows:

I have read and understood Beginning Experience and Your Privacy document and give permission for the local Beginning Experience Team to use my personal information collected in this form on the manner described in that document. Only one option can be selected, to change unclick selected option.

Agree(*)

Yes

No

Invalid Input

Spam check(*)

Invalid Input

Main Menu

Contact Details

Auckland Team:

Kelly 027 686 4416

Lynda 027 489 8003

BE Weekend Application

They are impressed with our support

Latest Updates

Popular Articles

Resources