The Shark Cage Program
Registration of Interest
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Email
example@example.com
Address
*
Street Address
City
State / Province
Postal / Zip Code
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To achieve the best outcomes, participants are encouraged to attend all sessions. Are you able to commit to attending all six sessions? The program will be held on 11 August, 18 August, 1 September, 8 September, 15 September, and 22 September.
*
Yes, I can
No, I can't
Unsure — please call to discuss
This program supports women who have experienced abuse at different stages of their lives, from childhood through to adulthood. Do you understand the focus and purpose of this program?
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Yes, I do
No, I don't
To help ensure the program is the right fit and provides the best support for you, we ask participants to attend a face-to-face conversation with one of our team members. Are you able to commit to this meeting?
*
Yes, I can
Unsure — please call to discuss
Are there any learning adjustments or support needs we should consider to help you fully participate in the program?
At this early stage of the program, we are unable to provide childcare. Do you have any young children (0-5) who may be with you during sessions? We understand the realities of our community, but we do need to be aware of any children who may be present so we can plan accordingly and best support all participants.
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