Click here to GIVE A BRICK and help build homes for younger adults living with complex physical disabilities
Contact us to tell us about yourself and the support you need. You can also ask other agencies to refer you to Enliven Disability services.
Please complete the interest form below and we will contact you.
Your name(s) *
Date of birth *
Gender MaleFemaleGender DiversePrefer not to say
Ethnicity NZ EuropeanMāoriPacific PeoplesOtherPrefer not to say
Work and Income Number *
ORS Number
Home address *
Home phone *
Mobile
Email *
Emergency Contact - Name *
Relationship to you *
Phone *
Mobile*
Email*
ServicesVery High Needs SupportAdult Learning (TEC)Transition from SchoolI don't know
Any costs related to the services you have enrolled in are to be charged to:
Name
Address
Email