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Request for Help
We all need a little extra help from time to time. There is no shame or embarrassment in requesting some help. Be assured your request will be handled confidentially . Please supply ALL the information requested on the form so that your request can be processed without delay*** Please Note: Our primary concern is to support Papamoa FAMILIES in desperate need of short term food support. Our deliveries are made on Thursdays - 10.00am to 1.00pm Applications are accepted up to 4pm Wednesday Client must be present to receive the delivery and have photo ID to confirm identity. You may be asked to provide further documentation so that your application can be considered. Please be sure to be honest with the information you provide.
I need some extra help with:
Food Parcel
Financial - Budgeting/Mentoring
Applicants name
*
First name
Last name
Your Cell phone
*
Your Email address
*
Household Address
*
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Your Date of Birth
*
Gender Identity
*
Female
Male
Other
Ethnicity
*
NZ Euro
Maori
European
Pacifica
Asian
Other
Employment
*
Accident Compensation (ACC)
Self Employed
Full time
Part time
Student
Not employed
Other
Residence
*
Freehold
Mortgaged
Rental
Govt.
Social
Emergency
Other
Known Allergies
*
Please ensure that you check all food packaging yourself before consuming any food or using any products provided by Papamoa Food Hub to ensure that products are suitable for use and/or consumption. Papamoa Food Hub does not accept any liability for any adverse reactions experienced.
Please click below and enter all dependants and members of this household
Click Here
Persons name
*
First name
Last name
Date of Birth
*
Gender Identity
Female
Male
Other
Relation to Household
*
Applicant
Child
Partner
Allergies
*
Partner Employment
Accident Compensation (ACC)
Self Employed
Full time
Part time
Student
Not employed
Other
Single line text
+ Add further dependants /members of household
- Remove
Tell us a little about yourself and your situation, and what brings you to PFH for food support.
*
How did you hear about Papamoa Food Hub?
*
Kitchen/Cooking Facilities
*
Air Fryer
Cooktop
Crock Pot
Freezer
Fridge
Microwave
Oven
Are there any dangers our delivery team need to be aware of? Such as COVID or any other gastro or contagious illnesses.
*
Have you applied for OR received any food support from ANY agencies in the past 12 months?
*
No
Yes
If Yes please specify from where and when
As a PFH client do you authorise PFH to share information with other food support agencies? If you answer NO, you will be asked to explain why.
*
No
Yes
I would like to receive the Papamoa Food Hub Newsletter
Thank you, one of our team will be in touch soon to discuss how we can best deliver your request.
Please check the highlighted fields
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