GRG NEW Member Registration Form

GRG NEW Member Registration Form

Membership and access to GRG's services is free to all fulltime grandparent or other whanau or kin caregivers. Please fill in the form below and click the 'SUBMIT' button at the end. Further information may be required from you to best support you and your family. All personal information is securely and confidentially held in accordance with all applicable laws of New Zealand.
Your Full Name*

First NameMiddle NameLast Name
Your Gender*

FemaleMale
Your Date of Birth*

MonthDayYear
Please enter your address in all four lines below. If your address does not contain a Suburb or second line please type "-" in that box below.
Home Address*
Region in NZ where you live*
Postal Address if different from above
Your Contact Phone Number*

Prefix Remaining numbers
Other Contact Phone Number

PrefixRemaining numbers
Your Contact Email Address
example@example.com
Please select the MAIN ethnic groups you identify with. (Note: Limited to TWO groups).*
(Optional) Please tick all ethnic groups you belong to.
What type of Caregiver are you?*

GrandparentGreat-grandparentKin / Whanau CarerFoster Carer
Do you have a partner/spouse who is to share membership of GRG with you?

YesNo
If you selected YES to the above question, please provide your partner or spouse's details here.
Your Partner's Full Name

First NameMiddle NameLast Name
Your Partner's Gender

FemaleMale
How many children are you raising?*
How many years have you been raising your grandchildren / someone else's child? *
For the period you have been raising, please indicate the circumstances that best suit you.

I've been raising for a continuous periodI've had the child/ren in my care on and offI don't currently have the children in my care, but expect to soon
Please complete the information below for each child in your care. Click the 'Add Another Child' button to add further children.*
(Optional) Has there been any Oranga Tamariki (or CYFS) involvement with any of the children in your care in the past? If yes, please state briefly which child/ren and when?
(Optional) Please select all issues for which you need support or advice

Financial and Income SupportGuardianship / ParentingFamily CourtLegal aidOranga TamarikiSpecial Needs / DisabilitiesCounsellingGeneral informationGRG NewsletterHousing
(Optional) Please provide us with a brief outline of your situation and what you need help with. We will contact you shortly to discuss next steps with you.
How did you hear about GRG or who referred you to GRG? *
If you selected 'Other' above, please state who referred you to GRG or how you heard about GRG below.
Our local GRG Support Coordinators can also provide additional local support, information, workshops and/resources that may be of benefit to you and your whanau/family. Do you give permission for your contact details to be provided to the GRG Support Coordinator in your area? (Note: not all areas in NZ are covered at present. Please refer to our website "Local Support" for more information)*

YesNoMaybe later
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