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? *
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 )                                                   *
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) *

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.

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Have (CCTV) home cameras? We can supply 3 free “Warning” stickers  

Please tick YES if you would like 3 or NO if you do not want any

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Would you like information about training to be a Neighbourhood Support Waitakere representative for your area or group?  *
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