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?
Yes No

Is this a whāngai/adoption pregnancy/baby
Yes No

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 smokefree?
Yes No

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?
Yes No

Whats the best way to contact you?

Last updated: Friday, May 6, 2022