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Loving Arms Support Form 2024
All details will be kept confidential.

More than one child? ......Please register for each child in separate forms.
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Email address of family *
Name *
Street Address including suburb (Motel Name and Room Number if applicable)
Town/City *
Required
Contact Phone Number - Please note that if you do not supply a contact number we are unable to process your request.
Age *
Required
Ethnicity *
Required
Expected Due Date/Baby's Birth Date *
MM
/
DD
/
YYYY
Sex of Baby *
Required
Referred By *
Required
Item/Support Needed *
Required
Comment (Also include nappy size, shoe size and babys weight)
If you are filling in this form on behalf of someone else please include your name, your role and contact phone number here. Also please ensure that you have the permission of the person you are registering.
Please note that we will do our very best to supply all that you have requested but bear in mind that we rely on community donations of items....so unfortunately if we don't have it we can't supply it. Please check the box once you have read the above. *
Do you consent to being emailed a feedback form? *
If you have identified yourself as NZ Maori, it you know what Iwi you belong to please add below.
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