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Application

This document is an application form for Waiariki House, a hall of residence. It requests basic contact information from the applicant such as name, address, email, phone number, emergency contact, age, institution/place of employment, course of study, medical conditions, criminal convictions, and signature agreeing to give two weeks notice before leaving and abide by house rules. It also notes a $25 per night twin share or $30 per night single room rate if staying less than 30 days.

Uploaded by

Rachel Anne Harker- Ferguson
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
20 views

Application

This document is an application form for Waiariki House, a hall of residence. It requests basic contact information from the applicant such as name, address, email, phone number, emergency contact, age, institution/place of employment, course of study, medical conditions, criminal convictions, and signature agreeing to give two weeks notice before leaving and abide by house rules. It also notes a $25 per night twin share or $30 per night single room rate if staying less than 30 days.

Uploaded by

Rachel Anne Harker- Ferguson
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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WAIARIKI HOUSE

Hall of residence
APPLICATION FORM
Date of application

Name.
Preferred Name....
Contact Address
...
Email Address
Phone.....................Passport / Driver Licence Number.
Emergency Contact Person..................
Phone
Age (Circle)

18 25

25 35

Over 35

Learning Institution / Place of Employment


Course of Study
Medical Conditions..
...
Criminal Convictions..

I agree to give two weeks notice of my intention to leave Waiariki House


I agree to abide by the rules and regulations of Waiariki House
I understand that if I stay less than 30 days I will be charged $25 per night twin share / $30 per
night single

SignatureDate..

OFFICE USE ONLY

Directors Approval

Required/Not Required

Date of application
Accommodation

Available / Not available

Directors signature.

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