1. The person who completes this form must note their name. In instances where a whānau member, staff member and or caregiver signs on behalf of the member, that person must note their name and relationship to the member. In the case of children (0 to 15 years), a legal guardian must confirm declaration on behalf of the child.
2. Please ensure that the entire form is verbally read to a kāpō person before completing the form.