CCNZ IBD Camp Registration of Interest
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Questions marked with an * are required Exit Survey
 
 
This brief questionnaire is for a Registration of Interest for patient attendance at Crohn’s Colitis NZ Children’s/Teen Camp

Sunday 25th – Friday 30th January 2015, Camp Adair, Papakura, Auckland.

Please answer all questions as honestly as possible. You should leave us a phone number or other form of contact so we can contact you in the future.

Thank you very much for completing this!
 
 
 
* What is your full name?
   
 
 
 
What is your address?
   
 
 
 
What is your phone number?
   
 
 
 
What is your email address? If you do not have an email address, please put your parent's, caregiver's, or other relatives email address.