Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Ethnicity ( Tick all that apply ) *

Māori

Pacific Islander

Pākehā / European

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

First Name

Last Name

Emergency Contacts Phone *

(###)

###

####

Are you attending as *

A Single Parent ( Rangitahi Mama/Papa)

Parenting Couple

Whānau Support (Rangatahi Participant)

What challenges or barriers are you currently facing in achieving your goals? (Select all that apply) *

Access to childcare

Financial constraints

Limited cultural connection

Social isolation

Lack of career or educational opportunities

Physical Wellbeing

Mental Wellbeing

Other

What specific goals or outcomes do you hope to achieve through participation? (Select all that apply) *

Strengthening cultural identity

Developing personal or family goals

Improving physical health and fitness

Building stronger relationships with family and community

Exploring career or business opportunities

Other

Participation Commitment - Can you commit to attend 2 of the noho wānanga series? *

This programme follows a holistic approach, with each wānanga building upon the previous one to create a journey of personal, cultural, and relational growth. Full attendance is vital for participants to benefit from the entire experience.

Yes

No

Do you speak or have an interest in learning Te Reo Māori? *

Yes

No

Do you have supportive network of peers, or are you seeking to form these?

Yes

No