Registration Form – Breakaway Ashburton

Don’t miss out on our action-packed programme for 18-28 April 2017!

Thanks for your interest in the upcoming FREE Breakaway Holiday Programme in Ashburton. There are heaps of fun activities planned – something different every day – so you’re in for an awesome time! You bring your water bottle and lunch every day, and we’ll provide the fun!

Now, just fill out the form below, hit send, and we’ll be in touch soon to confirm your registration.

Full Name (required)

Mobile/Home phone number (required)

Home address (required)

Email (required)

Gender (required)

Age (required)

Ethnicity (required)

THANKS TO ALL OF OUR AWESOME SUPPORTERS