GRG NEW Member Registration Form

GRG NEW Member Registration Form

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. In any case, all personal information is securely and confidentially held in accordance with all applicable laws of New Zealand.
Your Full Name *

First Name Middle Name Last Name
Your Gender *

Female Male
Your Date of Birth *

Month Day Year
Home Address *
Region in NZ where you live *
Postal Address if different from above
Your Contact Phone Number *

Area Code Phone Number
Other Contact Phone Number

Area Code Phone Number
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? *

Grandparent Great-grandparent Kin / Whanau Carer Foster Carer
Do you have a partner/spouse who is to share membership of GRG with you?

Yes No
If you selected YES to the above question, please provide your partner or spouse's details here.
Your Partner's Full Name

First Name Middle Name Last Name
Your Partner's Gender

Female Male
How many children are you raising? *
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 Support Guardianship / Parenting Family Court Legal aid Oranga Tamariki Special Needs / Disabilities Counselling General information GRG Newsletter
(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) *

Yes No Maybe later
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