Whanau Covid Response Survey
Rongomaiwahine Iwi Trust are in the process of updating our Iwi response plan.
As Mahia is heading into the summer season and our population increases to well over 20,000 with people coming and going we want to ensure that our whānau and community are all kept safe and well.
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Residence (Address in Mahia) *
Are you comfortable sharing some of your information with me *
Name (e.g J Smith)
Best point of contact: (Phone, email, messenger)
Are you Vaccinated? *
We are encouraging each whānau to create their own response plan and we can help with this, which family members will be in your bubble if a lockdown was to occur again?
(You) #1
Person #2
Person #3
Person #4
Person #5
Person #6
Person #7
Person #8
NB- 4yr
5-11yr
12-17yr
18-30yr
31-40yr
41-64yr
65+
80+
which family members in your bubble are vaccinated or want to be?
Child U12
1st Dose
Both Doses
Unvaxxed
Wanting to Vaccinate
Rather not say
(You) #1
Person #2
Person #3
Person #4
Person #5
Person #6
Person #7
Person #8
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