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1. Please confirm your name (Required.)

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2. Please confirm your email address (Required.)

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3. Please confirm your phone number (Required.)

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4. Including you, how many adults are in your household? (Required.)

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5. How many dependent children are in your household? (Including shared custody) (Required.)

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6. What part of the Queenstown Lakes district do you currently live in? (Required.)

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7. Does anyone in your household experience any serious or ongoing health challenges that impacts functioning or mobility? (Required.)

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8. What is your HOUSEHOLD annual income before tax? (Required.)

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9. What is the total amount of HOUSEHOLD savings you currently have (not including KiwiSaver)? (Required.)

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10. What is the total HOUSEHOLD balance of your KiwiSaver account(s)? (Required.)

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