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Nickname
*
Title
First Name
*
Last Name
*
Organisation
On behalf of this Organisation
Are you Deaf or Hard of Hearing?
Yes
No
Second Parent/Caregiver First Name
Second Parent/Caregiver Last Name
Are you Deaf or Hard of Hearing?
Yes
No
Email
Phone Number
Mobile
Date of Birth
Suburb
Please select your suburb
City
Country
Country
Search for your address
Search for your address
Address
Address 2
Suburb
City
Post Code
State/Region
Region
Please complete the information below, to the best of your ability, about your Deaf or Hard of Hearing Child.
DHH child 1 DOB and name
Childs Name
The below questions are not mandatory, any and all information gathered is managed in line with our data and privacy policy.
Miss
Your child’s hearing level as diagnosed- Left Ear
Mild
Moderate
Moderately-Severe
Severe
Profound
Don't Know
Prefer not to answer
Your child’s hearing level as diagnosed- Right Ear
Mild
Moderate
Moderately-Severe
Severe
Profound
Don't Know
Prefer not to answer
Devices your child uses- Left Ear
No device
Hearing aid
Cochlear Implant
BAHA
Prefer not to answer
Devices your child uses- Right Ear
No device
Hearing aid
Cochlear Implant
BAHA
Prefer not to answer
If none of these descriptions fit for your child, please describe your child's hearing level, in your own words.
Please feel free to add information about your child here, such as if they have additional disabilities or face challenges with their health and education experiences. This information will help us to design our events and opportunities to best meet the needs of our community.
Click below to add details for another Deaf or Hard of Hearing child
I have another Deaf or Hard of Hearing child
DHH child 2 DOB and name
Childs Name
Your child’s hearing level as diagnosed- Left Ear
Mild
Moderate
Moderately-Severe
Severe
Profound
Don't Know
Prefer not to answer
Your child’s hearing level as diagnosed- Right Ear
Mild
Moderate
Moderately-Severe
Severe
Profound
Don't Know
Prefer not to answer
Devices your child uses- Left Ear
No device
Hearing aid
Cochlear Implant
BAHA
Prefer not to answer
Devices your child uses- Right Ear
No device
Hearing aid
Cochlear Implant
BAHA
Prefer not to answer
If none of these descriptions fit for your child, please describe your child's hearing level, in your own words.
Please feel free to add information about your child here, such as if they have additional disabilities or face challenges with their health and education experiences. This information will help us to design our events and opportunities to best meet the needs of our community.
Name(s) of sibling(s) to Deaf or Hard of Hearing child.
Sibling 1 DOB and name
Sibling 1 Name
Sibling 2 DOB and name
Sibling 2 Name
Sibling 3 DOB and name
Sibling 3 Name
Sibling 4 DOB and name
Sibling 4 Name
Please tell us if you, or your children use New Zealand sign language to communicate?
Yes
No
Prefer not to answer
Many funding agencies and Government departments require us to report statistical information about our membership base. Knowing which ethnicities you and your family identify with may allow us to access funding opportunities that are provided for specific ethnicity groups.
You may select multiple options to reflect each family member
NZ European
Maori
European
Pacific People
Asian
Middle East
Latin America
African
Other
How did you find out about APODC?
Adviser on Deaf Children
The Hearing House
Deaf Aotearoa
First Signs
Ko Taku Reo
Auckland Deaf Society
Member referral
Facebook
Internet search
Word of mouth
Other
DECLARATION (please tick as applicable):
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
*
Denotes mandatory field
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Just a few last questions
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No
Yes
No
Yes
No
First name
Last name
Email