Warrandyte Neighbourhood House Enrolment Form

Warrandyte Neighbourhood House Inc. 168 Yarra St Warrandyte  VIC  3113 Tel:  9844 1839 Fax:  9844 4088 E-mail:  WNH Office

ENROLMENT GUIDELINES

1.    Enrol by completing this form and submitting it on-line by clicking the SUBMIT button at the bottom when you are ready;
       OR
       download a hardcopy of the enrolment form and either post/fax it to us or enrol personally during office hours.

2.    We cannot enrol any person unless we receive an enrolment form and payment.
       Payments can be made by :
       cheque, mailed or at the office;
       credit card (VISA, MASTERCARD, BANKCARD only) by phone or at the office;
       cash payment at the office.

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PLEASE FILL IN ALL SECTIONS AND SUBMIT THE FORM, THEN CONTACT THE OFFICE ON 9844 1839 TO CHECK FOR ENROLMENT AVAILABILITY AND MAKE ANY REQUIRED PAYMENTS.

* indicates a required entry

* COURSE(S) REQUESTED

* Family Name
* Other Name(s)
* Address
* Suburb
* Postcode
Phone Numbers Please supply at least one number	* primary contact alternative contact  mobile
* E-mail
* Confirm E-mail address

Have you had any previous involvement in WNH?           

No/Yes Please select No Yes
(e.g. courses attended, volunteer work, committee member)
If so please provide further information below.

INFORMATION REQUIRED BY FUNDING BODIES (this information will be de-identified by detaching it from your personal information above)

* Country of Birth
* Language spoken at home
* Aboriginal or Torres Strait Islander?	Please select NO YES
* Do you have a disability?	Please select NO YES
* Age Group	Please select an age group 12 years or less 13 - 24 years 25 - 60 years Over 60 years
* Manningham Resident	Please select NO YES
* Gender	Please select Female Male

The information entered above will be submitted to the office at WNH,
please call the office on 9844 1839 to check for enrolment availability
and make any required payments.

	Click to submit enrolment form
	Click to clear form fields

Thank you for your interest in Warrandyte Neighbourhood House courses