Rolleston, Canterbury (Monday, 10th February

Pronoun

First Name *

Last Name *

Which ethnic group do you belong to? *

New Zealand European
Māori
Samoan
Cook Islands Māori
Tongan
Fijian
Chinese
Indian
Filipino
Other (Please state: e.g., Dutch, Japanese, Tokelauan, Fijian-Indian, Niuean)
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 *

I understand that my personal information will be used by Plunket to deliver the services I am signing up for, and to help Plunket understand the needs of the community. *

I consent to my information being shared within Plunket, to connect me with post-birth courses and support.

Rolleston, Canterbury (Monday, 10th February - 17th March 2025)

Pregnancy & parenting education,
information and resources

Please select your region and course location from the menu above to register

Class Details

Class Information

Class Registration Form

To be completed by the Mother-to-be