Recreation Camp Expression of Interest

YMCA Wainui Park Camp
7th - 11th December 2026

The Halberg Foundation are accepting Expressions of Interest for our Outdoor Recreation Camp from young people aged 17–21 years old with a physical or visual impairment.

 

Please note that all participants should be able to independently manage their personal cares, transfers and medication throughout this fully immersive course. We ask that you fill out this form honestly and to the best of your knowledge – the more accurate the information we have, the better prepared we can be so to ensure the best quality experience possible.

 

We aim to keep costs as low as possible for families, and have some great partners and funders on board to help with this. The camp at Wainui costs around $450 per person for the week.

Thanks to our partners and funders, Halberg will cover the full cost of the camp for all participants. The cost of transport to and from Christchurch will remain the responsibility of the participant and their whanau.
 

Once we have received your completed Expression of Interest, the selection process will begin. We will advise all applicants by 23rd October 2026. If you are successful, you may then begin the steps of booking your flights which we will provide more info on at that stage.

Personal Details












Address



















Emergency Contact Details







Please select the option that is most relevant to you 
100m, 2 Mins 100m, 3 Mins 100m, 4 Mins 100m, 5 Mins
10 Mins 15 Mins 20 Mins With Assistance
Yes No With Assistance
Yes No
Will be fine Needs Assistance








1. I understand the attached medical form will be used to ensure my safety and agree to the information being shared with supervisors/outdoor instructors or any medical professional responsible for my care.

 

 

2. If there is an accident/incident, I authorise qualified medical practitioners to take necessary steps to ensure my wellbeing.

 

 

3. I have filled out this form with all the relevant information that will be required for this camp. I understand the information will be used to ensure my safety and agree to the information being shared with supervisors/outdoor instructors or any medical professional responsible for my care.

 

 

4. If successful, I am willing to fully participate in the camp, comply with all instructions, and respect others, their beliefs and belongings.

 

 

5. I give consent for The Halberg Foundation and YMCA to contact my next of kin in the event of a medical necessity and give consent for the disclosure of personal medical information to my next of kin.

 

 

6. I acknowledge that while the supervisors / instructors will make every reasonably practicable effort to ensure my safety, there are inherent risks associated with these activities that cannot be foreseen and are beyond the control of the supervisors/ instructors.

In order to promote the work of the Halberg Foundation, we often profile those attending our events on social media, as well as in print/online public relations material including video footage. All material collected is used specifically to enhance the work of the Halberg Foundation. Images and content may also be supplied to external news media and Halberg sector partners to further achieve this goal. It is important for our ongoing success that we continue to develop this material. Media will also be invited to attend and film attendees participating in the event. 

 Please advise below if you are happy that we, and any other party we contact, use images or video footage that may include you, taken during this event. If you are under 18, please ask a parent/guardian to read this form and tick the below to confirm. On behalf of the Halberg Foundation, thank you for your co-operation. 

 By registering to attend this event, I confirm that I (or my parent/guardian if I am under 18 years of age) give permission to be photographed and/or filmed and I am aware of and consent to the following: 

  Photographs or films I feature in may appear in Halberg Foundation material, including the Halberg Foundation’s website, social media, print media and public relations material. 

Photographs and film material may be shared with sector partners such as, Sport New Zealand, Paralympics New Zealand and the Parafed Network. 

Photographic or video footage I feature in may be used to promote future events associated with the Halberg Foundation. 

Media may photograph or film me at this event. 

I have the right to access all images and video footage held by the Halberg Foundation in relation to me. 

 I also confirm that this consent is given voluntarily and I understand that it may be withdrawn by me (or my parent/guardian if I am under 18 years of age) at any time, upon written notice. 

Contact Information