Queenstown, Southern (28th November- 10th December 2022)

Pronoun *

First Name *

Last Name *

Which ethnic group do you belong to? *

New Zealand European
Māori
Samoan
Cook Islands Māori
Tongan
Niuean
Chinese
Indian
Other (Please state: e.g., Dutch, Japanese, Tokelauan)
I do not want to state my ethnicity
I don’t know my ethnicity

Please state ethnic group :

Home Phone Number

Street Address *

Suburb *

Town/City *

Postcode *

Country *

Cell Phone Number *

Email Address *

Date of Birth *

Due Date *

Is this your first baby? *

Additional information: Twins, Medical Conditions etc*

Name of your Midwife *

Your NHI number (3 letters & 4 numbers)

Allocation

Partner's Name (If applicable)

Prove you're not a robot *

Subscribe to: Receiving further information/ invitation to Plunket services

Queenstown, Southern (28th November- 10th December 2022)

Pregnancy & parenting education,
information and resources

Class Details

Class Information

Class Registration Form

To be completed by the Mother-to-be