Life After Separation: Successful Co-Parenting Workshop

Life After Separation: Successful Co-Parenting Workshop

Registration Form
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Gender

FemaleMaleTransgender Male (FTM)Transgender Female (MTF)Non-binaryOther
Pronouns
Do you identify as Aboriginal or Torres Strait Islander?

NoYES - Aboriginal AustralianYES - Torres Strait Islander AustralianBOTH Aboriginal & Torres Straight Islander Australian
Do you identify as Culturally and Linguistically Diverse (CALD)?

YesNo
Emergency Contact Name:
Emergency Contact Number:
To ensure we do not book you in to the same Workshop as your ex-partner, please provide their name below:
Name of Ex-partner:*
If this is not provided, we can't register you.
Do you have contact with your Ex-partner*

YesNo
Do you have contact with your children?*

YesNo
Is there a current FVRO or Conduct Order in place?*

YesNo
Please select the workshop date you wish to attend as well as a second preference in the event that we cannot enroll you into your preferred date. Dates are on our webpage Life After Separation.
First Preference
Second Preference
How did you hear about our Workshop?*

Court OrderedLifeline WA WebsiteCurrent / Previous ClientOther
Is there any other information you'd like to share?
Once this completed registration is submitted, you will receive an email confirming your registration and details of the date, time, location, and any other relevant information.
Should be Empty: