Circle of Security Registration Form

Circle of Security Parenting Programme
Registration Form
Next course: Term 4
15 October - 3 December 2025
Course Time*
Select your preferred course
Participant Name*

First NameLast Name
Are you an existing Dayspring Client?*

NoYes
There is a cost of $200 to attend this programme.

A non-refundable, non-transferrable deposit of $20 is required to secure your place in the programme, with the remaining balance due one week before the course start date.

Please make your deposit using your name as the Reference into the following bank account:

Bank: ASB
Account No: 12-3034-0653812-00
Account Name: Dayspring Trust
A non-refundable, non-transferrable deposit of $20 is required to secure your place in the programme.

Please make your deposit using your name as the Reference into the following bank account:

Bank: ASB
Account No: 12-3034-0653812-00
Account Name: Dayspring Trust
Do you need funding to cover the course fee?*
Please note that you will need to pay a $20 deposit to secure your place in the programme.
Dayspring will fund the remaining $180 course fee.
Please let us know how much you can afford to contribute:
Gender*
Birth Date*

DayMonthYear
Phone Number*
E-mail*
Address*

Street Number and Street Name

Suburb

CityState / Province

Postal / Zip Code
How old is your child/children*
Age/s
Do you need to use our on-site creche (under 3 year olds only) while you attend the programme?*
The creche costs $20 per family for the 8 week programme duration. Course funding does not cover creche fees.
Are you struggling with anything in particular with your child?
How did you hear about this programme?*
ie. From a friend, GP, Google search, Plunket etc.
Any additional information:
Should be Empty:

Circle of Security Parenting ProgrammeRegistration Form

Circle of Security Parenting Programme
Registration Form