Kāinga Tau Registration

Kāinga Tau is dedicated to help all those in a Rental Agreement within the Taupō and Tūrangi.

Please complete the form below and one of our team will be in contact. At this time our kaimahi will be in contact with you in the New Year.

Client Information

Name *

Street Address *

Town

Email Address

Phone *

Date of Birth *

Gender

How many adults live in the whare? *

How many children under 18yrs live in the whare? *

MSD Client Number (if applicable)

Housing Type *Must have a rental agreement in place.

Reason for Referral

Consent *

I agree to be provided with information about the service and have the following processes explained to me before engaging.

He Iwi Kāinga complaints process
Advocacy services
My rights as a client
Confidentiality / privacy of information
Consent to sharing of information
How to exit, leave programme
Information used as case studies (unidentified) for our Funders Report
Use of your images for advertising (where applicable

Signature

Start signing your signature here

By signing this form, I acknowledge and understand the information will be given to me and I am aware that I can clarify any aspect of my consent at any time. This consent will be reviewed annually or at any time at my request. I acknowledge that staff working with me and others who are involved in my plan or programme may need to share health information to ensure I receive a quality service. I acknowledge that staff will only share my information with other services, as necessary.

Referral Details

If Applicable

Name

Organisation

Phone

Email Address

Would you like to receive confirmation this has been completed.

Consent *

Yes, I acknowledge that I have informed my client of the services offered by He Iwi Kāinga and my client has provided their consent to connect and that their personal information has been shared with He Iwi Kāinga.