ONE DAY COMMUNITY WĀNANGA: CONSENT TO PARTICIPATE FORM- of Gambling for Families and Communities: A Strengths-Based Approach to Achieving Whānau “Impacts Ora” Name: Organisation: Contact Number(s): Iwi Affiliation(s): Disclosure details: Please read the following: I have been given an explanation of this project I understand the information I have been provided about the project I have had an opportunity to ask any questions and had them answered to my satisfaction I understand that any information I provide will be restricted to this project only I understand that my individual identity will not be disclosed in any way, shape or form in the final report I understand that I may withdraw myself, or any information I have provided from this project at any stage, without giving any reasons for doing so I understand that some wānanga activities will be recorded with an audio tape and that a summary of all information gathered, will be given back to me I understand that an interpreter may be requested (see below) I have read all of the above details and understand them fully. I agree to all of the above details and agree to participate in this project. Participant Signature & Date Researcher Signature & Date REQUEST FOR INTERPRETER English I wish to have an interpreter Yes No Māori E hiahia ana ahau ki tetahi kaiwhakamaori/kaiwhaka pakeha korero Ae Kao Pou Tuia Rangahau - Te Rūnanga o Kirikiriroa Trust Inc 159
ONE DAY COMMUNITY WĀNANGA: CONSENT TO PARTICIPATE FORM- “Impacts of Gambling for Families and Communities: A Strengths-Based Approach to Achieving Whānau Ora” Name: Organisation: Contact Number(s): Iwi Affiliation(s): Disclosure details: Please read the following: I have been given an explanation of this project I understand the information I have been provided about the project I have had an opportunity to ask any questions and had them answered to my satisfaction I understand that any information I provide will be restricted to this project only I understand that my individual identity will not be disclosed in any way, shape or form in the final report I understand that I may withdraw myself, or any information I have provided from this project at any stage, without giving any reasons for doing so I understand that some wānanga activities will be recorded with an audio tape and that a summary of all information gathered, will be given back to me I understand that an interpreter may be requested (see below) I have read all of the above details and understand them fully. I agree to all of the above details and agree to participate in this project. Participant Signature & Date Researcher Signature & Date REQUEST FOR INTERPRETER English I wish to have an interpreter Yes No Māori E hiahia ana ahau ki tetahi kaiwhakamaori/kaiwhaka pakeha korero Ae Kao Pou Tuia Rangahau - Te Rūnanga o Kirikiriroa Trust Inc 159