Music, Play & Connect
Please complete this form to register for your selected program and provide consent for participation and data collection.
We are interested in attending the below session (please select ONE of the below options :
*
Please Select
10am-10:30am(session FULL)
10:45am-11:15am (session FULL)
Either session - WAITLIST
Child First Name
*
Child Last Name
*
Child Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Child Country of Birth
*
Child Gender
*
Please Select
Male or Man
Female or Woman
Non-binary
Prefer not to say
Suburb
*
Do you speak a language other than English at home?
*
No
Yes — please state
If yes, language spoken at home
Is your child Aboriginal and/or Torres Strait Islander?
*
No
Aboriginal
Torres Strait Islander
Both Aboriginal and Torres Strait Islander
Does your child have one or more of the following impairments, conditions or disabilities?
*
Intellectual learning
Psychiatric
Sensor/speech
Physical/diverse
Prefer not to say
None
Parent / Guardian First Name
*
Parent/ Guardian Last Name
*
Parent / Guardian Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Parent / Guardian Country of Birth
*
Is parent/guardian Aboriginal and/or Torres Strait Islander?
*
No
Aboriginal
Torres Strait Islander
Both Aboriginal and Torres Strait Islander
Does parent/guardian have one or more of the following impairments, conditions or disabilities?
*
Intellectual learning
Psychiatric
Sensor/speech
Physical/diverse
Prefer not to say
None
Contact Email
*
example@example.com
Contact phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
As part of our funding agreements, we need to record this information in the DSS Data Exchange. Would you prefer it was recorded anonymously?
*
Yes
No
To help funders understand the effectiveness of our programs, they sometimes contact participants for feedback as part of the evaluation process. Would you like to be contacted for this purpose?
*
Yes
No
Would you like to be contacted by Our Community Project about our programs and/or to provide feedback directly to us?
*
Yes
No
Do you give permission for photographs and/or video images of your child and parent/guardian to be used by our organisation for promotional, marketing, and publicity purposes?
*
Please Select
YES
NO
Is your family currently eligible for or receiving any government-funded family support or assistance?
*
Please Select
YES
NO
(This information helps us understand the needs of participating families and support future funding opportunities. Your response will remain confidential.)
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