He Whai mō Te Ora Whānau Log Form 2024

Whānau Champion Details

This is where you place your details as the Whānau Champion

First name

Last name

I attended the He Whai mō Te Ora Wānanga Te Rarawa - Roma Marae The list will grow….

Whānau Member Details

This is where you enter details regarding your whānau member who has received a He Whai mō Te Ora Toolkit. Please ensure your whānau member understands that participation is voluntary.

Name of person who has received a toolkit

Ethnicity

Address

When was this toolkit given to your whānau member? Date…..

Whānau Champion Checklist

Please read this checklist with each whānau so they understand how to participate in He Whai Mõ te Ora. Once done, initial the final question on this page.

By accepting this toolkit, you are agreeing: To take part in the He Whai mō Te Ora Programme Use the resources provided within your whānau Complete the programme feedback form

Yes

I have read the above checklist with my whānau member who has received a He Whai mō Te Ora Toolkit and they are happy to continue with the He Whai mō Te Ora Programme.

Yes

Additional Comments