Hapū Wānanga Registration Form

 

To register for the Hapū Wānanga Programme please fill out all the form below:


 

Last name:
First name:
NHI: (If known)
Your date of birth:
Due date:
Is this your first pregnancy?

Is this a whāngai/adoption pregnancy/baby
Preferred wānanga date to attend?
Email:
Facebook name:
Phone number:
Other phone number:
Postal address
Your ethnicity: (eg Māori, Pakeha, etc)
Iwi:
Hapū:
 
Your midwife's name:
Your regular doctor's name or clinic: (eg Tui Ora, Carefirst - if you don't have one please say 'none')
Baby's father's name:
Baby's father's ethnicity:
Are you smoke free?
Do you have any allergies to food or medicines?
If yes, please provide details:
We encourage you to bring a support person to the wānanga
Name of support person:
Support person's phone:
Photographs will be taken throughout the wānanga. Do you consent to photos being taken and used for promotional material?
 
Whats the best way to contact you?

 



Last updated: Thursday, February 20, 2020

DHB - About Us | Contact Us | Find Us | Sitemap | Disclaimer | Ministry of Health | New Zealand Government | Taranaki DHB Private Bag 2016 New Plymouth 4342 | © 2010
v2.00