2023 Term 3 Lower Hutt Daytime Group

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Thank you for your registration of interest for the Mothers Network Lower Hutt Daytime Group.

Dates: Monday 14th August - Monday 18th September

Time: 10am-12.00pm

Location: Petone Community House

Please note this is not a confirmation, you will be sent a confirmation email separately.

Please fill in all information below and we will contact you as soon as possible to confirm.

Email *

First and Last name *

Preferred name *

Best contact number *

Free onsite childcare is provided. Do you require childcare? *

Yes

If yes to Childcare, please advise name and age of your child. *

Do you have any dietary requirements? *

Gluten Free

Dairy Free

Vegan

Vegetarian

Other*

Required

If you selected 'Other' please specify below

The course runs for six weeks and to get the most out of the group it is best (if you can!) to attend all six weeks. If you miss the first 2 weeks of the group unfortunately you will lose your place in the group. *

I acknowledge that the group runs for 6 weeks

It is helpful for us to know if you can contribute to our group cost (NB this is not a requirement, you can still attend) *

Yes, I can contribute the full $60 ($10 per week)

Sorry, I am not able to at this time

I can contribute another amount (higher or lower)

Anything else you would like us to know?

Single parent etc

What ethnicity best describes your identity? (This is for statistical purposes for funding)

Age (This is for statistical purposes for funding)

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