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First and Last Name
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Postal Address
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Email
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Home Phone Number
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Mobile Phone Number
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Course I want to enroll in
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Device Advice | Mondays | Appointment Only
Antenatal | Term 4 | 22nd October | FREE
ESOL Let's Speak English | Term 4 | 15th October | $20
Managing Stress & Anxiety | Term 4 | 31st October | $40
Community CV Clinic | Thursdays | $20
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(Space Only) : Baby Name, Gender, D.O.B.
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(Space only) 2nd Parent/ Partner Name, phone, email
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(Antenatal Only) : Due Date + support person name:
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Antenatal: Please note- Please fill out another enrolment for support person
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Ethnicity
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NZ European/ Pakeha
Maori
Tongan
Pasifika
Samoan
Asian
Indian
Latin American
African
Middle Eastern
Other
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I am a citizen of New Zealand (I was born in NZ or have a NZ passport)
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I am a resident of New Zealand (I have a NZ residence visa)
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No
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I am a migrant to New Zealand
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I came to New Zealand as a refugee
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Date of Birth
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Gender
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Male
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Diverse
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Highest Education Level
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No Secondary School qualifications
NCEA Level 1 or School Certificate
NCEA Level 2
NCEA Level 3 or New Zealand Bursary
Tertiary qualification (certificate, diploma or degree)
Overseas qualification
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How did you find out about this course?
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Facebook
KKCC Brochure
KKCC Newsletter
Google search
Browsing our website
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Midwife
Word of mouth
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Enrolments are automatically added to mail list. To Opt-out of Newsletter...
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Privacy Act 2020: The Katikati Community Centre wishes to collect the written details for registration purposes. This information will be accessible to Centre staff only. (For auditing purposes information gathered may be viewed by the Tertiary Education Commission)
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