Casting for Recovery® 2015 Application Form

A Breast Cancer Programme of Fun and Support

The weekend retreats are at no cost to you the participant apart from your travel should you be successful. CFR is for all ages and stages of breast cancer treatment and recovery. Please note, if you are secondary status and wish to apply we welcome your application; however you must have clearance from your medical provider and our CFR Medical Director. Your medical clearance must be provided at the time of application. Please take this form to show your medical care provider. He/She can then sign the medical clearance for you to send in with your application.

Medical Clearance Certificate

CFR retreat weekends are all about fun and support, incorporating the wonderful sport of fly fishing. Fly fishing allows the participant to enjoy the peace and tranquility of the outdoors and to be in the moment, where all they have learnt over the weekend is finally in practice on Sunday morning. Each participant has their own personal fishing guide for their time spent on the water. Secondary status applicants must be able to stand for periods of time and to balance in running water. The action of fly fishing involves whole body movement, some hip rotation and a full range of arm movement.

Date: / Name of Patient:
Medical Care Provider:
Provider Address:
Provider Email:
I certify that the abovementioned patient is medically fit to attend a CFR weekend.
Signed:
CFR retreat weekends are all about fun and support incorporating the wonderful sport of fly fishing. Fly fishing allows you the participant to enjoy the peace and tranquility of the outdoors and to be in the moment where all you have learnt over the weekend is finally in practice on Sunday morning.

Select your retreat

Please select which retreat you would like to attend then email it to the listed regional coordinator. If you don’t email, then make contact by phone and they will give you a postal address.

We politely ask you not to apply to more than one region at a time. Please note the next North Island retreats will be late 2015. Dates to be advised.

South Island, 24-26th April, 2015
Owen River Lodge, 173 Owen Valley East Rd, Owen River, Murchison 7073
Contact: Sally Robertson (South Island coordinator)
ph 03 528 6289
You will be notified in January 2014

Participants are sorted into regions then selected at random. Please note, if you are unsuccessful your application and medical clearance will be destroyed and disposed of with care. CFR does not retain past applications and we guarantee your privacy.

Name:
Address:
City: / Postal code:
Phone: / Mobile:
How did you hear about us?

Respectfully yours,

The CFR Retreat Coordinating Team