NS Waitakere Household Joining Form

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Email *

First name/s *

Last name/s *

Flat / Unit / number

House number *

Street name *

Suburb *

Postcode *

Home phone number

Work phone number/s

Mobile number/s

Number of people who live at your address?

Would you like to subscribe to receive our fortnightly email with Police Intel Stats? *

Yes please add me to receive your fortnightly Email with Police Intel Stats

No thank you

Please confirm your email address *

Do you or any members of your household have any medical / physical needs, Optional - (For emergency response contingency only) Please provide details

Are you or someone in your household over 65? (For emergency response contingency only ) *

Yes

Please provide the name of the person over 65 (For emergency response contingency only )

Do you give consent to be on your street's phone tree list? (If there is an existing active group for your street) *

Yes

Choose Your FREE Welcome Pack — Pick one option

**Please note - pictures are indicative only. There may be slight variations in the pack you receive, due to the availability of resources and updating at the time of making them.