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Lets talk About Sexuality – Workshops
Workshop Location *
Workshop date *
Name of person attending *
Date of Birth *
Gender *
Female
Male
Not specified
Indigenous Status *
ATSI
Non-ATSI
Language spoken at home *
Interpreter required *
Yes
No
Diagnosis: (if any) *
Any special access needs? (access, visual, hearing impairment) *
Are you registering as a group? *
Yes
No
Registering as an Individual? *
Yes
No
How many people are registering in this group? *
Which organisation? *
Accompanying Support worker
Name of Support worker *
Organisation *
Mobile *
Email Address*
Contact Person filling in form
Contact Person *
Role/Relationship *
Organisation *
Referring Contact *
Phone *
Email*
Brief description of learning and communication needs of person *
If you have any questionsplease contact:
Email :
info@birdandbees.com.au
Jodi Rodgers :
0422371331