Course you wish to enrol in

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Your details

Which ethnic group do you belong to? Mark the space or spaces that apply to you.

Separating partner's information

We need this information to ensure you and your separating partner are NOT booked on the same course.

Children's details

Information Sharing

The information you provide in this form is being collected by the Royal NZ Plunket Trust to enable you to participate in a free Parenting Through Separation Programme. The information you have provided may be used by the Ministry of Justice for the purpose of determining your completion of the course, tracking the progress of your family dispute, providing and/or managing the out of court family justice services they may provide or fund, validating accuracy of information provided or for determining whether your family dispute can proceed to court. Under the Privacy Act 2020 you have the right to have access to all information held about yourself, and to request correction of that information. To request access to, or correction of, any of your personal information collected for the above purposes, please contact: Privacy Officer, Ministry of Justice, SX 10088, WELLINGTON. Phone: 04 918 8800 Email: privacy.officer@justice.govt.nz.

Having issues with this form?

Please at pts@plunket.org.nz and let us know how we can help.
Need free support or advice?

Call PlunketLine 24/7 on 0800 933 922