Enrol

Enrolment Form

Please note this form is an expression of interest. Places in courses are not guaranteed until confirmed by Yarrunga Community Centre and payment has been received. If you would like further information about enrolling in a program at Yarrunga Community Centre visit the Enrolment Information page.

Course Information

 

Please enter the course name.

Please enter the day your course takes place.

Please enter the time your course takes place.

Personal Information

 

Please enter your first name.

Please enter your last name.

Please enter your email address.

Please enter your phone number.

Please enter your street address.

Please enter your suburb.

Please enter a state.

Please enter your postcode.


Please enter your date of birth.

Please enter your gender.

Please enter an emergency contact.

Please enter an emergency contact phone number.

Other Information

 

Please enter your country of birth.

Please enter if you are of Aboriginal or Torres Strait Islander origin.

Please indicate whether you have a disability.

Please indicate whether you require a carer.

Please indicate whether you have a concession card.

Please enter your concession card number.


Please enter you concession card expiry date.

Please indicate whether you'd like to become a member of Yarrunga Community Centre.

Please enter any additional information.

Please indicate how you found out about this course.

Declaration

Please read the Terms and Conditions and Code of Conduct. 

Please agree to our Terms and Conditions.

Please agree to our Code of Conduct.

Please confirm that the information you've provided is accurate.

Please agree to allow us to make decisions about your health and wellbeing in case of an emergency.

Please indicate whether you allow us to photograph you for marketing purposes.

You will automatically be added to our mailing list to receive news and updates from Yarrunga Community Centre, however you have the option to unsubscribe at any time.