YOUR DETAILS

First Name*

Surname*

Full Address *

Phone *

Email *

Date of Birth *

I would like to be contacted by emailcallsms

Do you have a medical condition or disability that may affect your ability to participate in this class?
NoYes
(Please inform your tutor at your first class. Activities may be able to be modified to suit your needs.)

Are you of Aboriginal and/or Torres Strait Islander origin? NoAboriginalTorres Strait Islanderprefer not to answer

In which country were you born? *

What language do you speak at home? *

EMERGENCY CONTACT DETAILS

Emergency Contact First Name*

Emergency Contact Surname*

Emergency Contact Phone *

COURSE DETAILS

Course to enrol in*

Course start date *

Course fee*

Where did you hear about the course*
FacebookDNH websiteFriendDNH ProgramOther

PAYMENT DETAILS

DNH will be in contact to confirm your booking and further details of the course.

Payments can be made by direct transfer BSB 033121 Account No 276995 using your surname and course in reference
OR by calling into the Neighbourhood House between 9am-3pm Monday to Friday.
Full payment must be made 2 weeks prior to the commencement of the course.

Preferred payment
BANK TRANSFERPHONEIN PERSON

Payment is required to secure you place and must be received at least 2 weeks prior.

PRIVACY STATEMENT

I understand that:
Darley Neighbourhood House and Learning Centre is required to provide the Victorian & Australian Governments with activity data which may include information provided in this enrolment form.
By signing this form and being accepted into your chosen course of study you agreed to adhere to all of Darley Neighbourhood House’s policies pertaining to student rights and responsibilities.
I acknowledge and agree to the terms described in this privacy statement:

I do not wish to be contacted about future events, classes and workshops at Darley Neighbourhood House and Learning Centre

I do not wish for my photo or video being taken and published to promote the activities of our House.

Any other questions/comments

When you press this "enrol now" button your answers should disappear and you will receive an email from us within 24hours. If it is not in your inbox, check your email spam folder. If you do not receive an email, please let us know at info@dnhlc.org.au
If you press this "enrol now" button and your answers do not disappear check for any answers you have missed or error messages.