The Otara Kai Village Food Support Referral Form 2021
Please note that all information you share through this form will remain private and confidential. We require all areas to be populated to ensure we provide you the best support.
Urgent essential need support offered by The Otara Kai Village through this registration form during Delta Lock-down are only available for delivery in the Otara-Papatoetoe suburbs on specific days. Addresses outside of these suburbs are likely not be processed or delivered. Our team does not work on the weekends so if you have sent a registration after 4pm Friday or through the weekend it will be checked on Monday. Please note that during the week days we do have drive through kai parcel picks ups that are available to ALL people. Follow our facebook page to find the days and times for non contact pick ups. For all other urgent essential need support please use our other registration form here - https://form.jotform.com/thecommunitybuildersnz/OKVDeltaRego
Yes I understand
Is this a self referral?
If NO please select referral source.
Other Social Service Provider
Please manually add the name of school, GP or service division (if applicable).
Are you reaching out for support due to the impact of Covid-19 on your life situation? *
How can we help?
Gift Voucher - I can purchase the items myself from Pak n Save.
Delivery Required - I have no transport
TELL US ABOUT YOURSELF
Your full name *
Date of Birth *
Your Age bracket *
Asian (Pan-Ethnic Asian, Indian, Filipino)
MELAA (Middle East / Latin America / Africa)
If Māori Iwi/Hapu (if applicable)
Include House number - Unit number (if applicable) - Street name
Street Address Line 2 - Suburb - This outreach is for residents of Otara which includes East Tamaki and Clover Park
State / Province
Postal / Zip Code
Please check your number is correct we will contact you on this number within 24 hours Monday to Friday. Submissions made on Friday will not be processed until Monday. NOTE - If you don't answer your phone you will not receive support on that day.
TELL US ABOUT YOUR CURRENT SITUATION
Are you in a Kainga Ora home? *
Marital Status *
De facto (3+ years)
Relationship (less than 3 years)
Separated but Co-Parenting
Grandparent raising moko's
Number of Tamariki in your care under 5years old? *
Number of Tamariki in your care aged between 6 - 13 ? *
Number of Rangatahi in your care aged between 14 - 18 ? *
Is Oranga Tamariki involved? *
Employment Status *
Reduced Hours due to Covid
Tell us more about your situation
Do require any medical masks
HAVE YOU BEEN VACCINATED AGAINST COVID-19? *
I'm still decided what to do
WHAT ARE THE BARRIERS STOPPING YOU FROM GETTING VACCINATED? *
Would you like to be added to our email list to be kept up to date with all other supports, services & updates for the Otara area? (Please note: You can un-subscribe at any time)
If you will receive a response from our team within 24 hours regarding your request. This support was made possible thanks to the support of Foundation North & MSD. Registrations received after 5pm each business day will be look at the following day. Click the link below to find other local supports during this lock-down and please check our facebook page for our regular weekly response plan that's available for you to access during the week as well. Kia Kaha whanau!
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