Enquiry Form

THE HOUSE OF GRACE ENQUIRY

If you want to know more about living at The House of Grace, please fill out a few details below.

We will also automatically send you information about living at The House of Grace and a link to apply if you want to do that now. Please check your 'junk' email folder if you don't receive anything.

What is your email address? *

This is the email address we will send the application link to

Confirm What is your email address?

Please tell us how you heard about The House of Grace: *

Please tell us why you are interested in the home: *

Are there any additional details that would be helpful for us to know:

Referral agency (if applicable)

Referrer's name

Referrer's number

Young person's details

Name

First name

Last name

Age *

Phone number

Ethnicity *

Due date or babys DOB *

If you are unsure please put an estimated date

Current city/town *

The information I have given is true and correct *

Yes

* You can view our privacy statement on The House of Grace website: www.thehouseofgrace.org.nz to find out how we manage your personal information *