Become a Member Application

Names of parent(s)/caregiver(s), adult Associate applicants, and Deaf youth over 18 yrs old *

First

Last

Name of deaf/hearing impaired child *

First

Last

Date of Birth *

Name(s) and date(s) of birth of sibling(s) to deaf child or deaf youth, and children of associate adults *

NOTE: Siblings, and children are included in your family/whanau APODC membership

Please tell us if you, or your children need sign language to communicate? Or if your child has any other needs that we should be aware of, eg medical needs, disabilities, or allergies? *

NOTE: We want to know how best to communicate with your family/whanau, and use this information to book interpreters, and to apply for funds

Ethnicity *

Home Address *

Home telephone number, and Mobile telephone number *

Email *

How did you find out about APODC?

DECLARATION (please tick as applicable): *

I agree to support, and not hinder, the mission and values of APODC (as below)
I give permission for photographs of my child/children, or those in my care, to be used by Auckland Parents of Deaf Children for promotional material.

Mission: The society promotes and facilitates informed, supportive and cohesive relationships between families and whanau with a deaf child, living in Auckland. We respect the individual choices which families and whanau make on behalf of their children and seek not to impose any particular perspective.

Signature (type your name) *

Date *

Message

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