Waimairi School Distance Learning Survey

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Please complete this form to let us know about your needs, or fill in on behalf of families you know, who do not have digital devices in their home for children to use for learning.

Privacy details: This information will be kept securely by Waimairi School and shared with the Ministry of Education for the purpose of assessing the need for delivery of digital devices and/or hard copies of distance learning resources.

PLEASE DO NOT FILL IN THIS FORM IF YOU DO NOT NEED A DEVICE DELIVERED TO YOU.

Family/Whānau name *

Child 1 name *

Child 2 name

Child 3 name

Address where staying during lockdown (please include postcode). This is needed for delivery of devices. *

Family/Whānau contact phone number *

Family/Whānau contact person's name *

Does this household have an internet connection with wi-fi which devices can connect to? *

Yes

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