Workshop Location *
Workshop date *
Name of person attending *
Date of Birth *
Gender *
FemaleMaleNot specified
Indigenous Status *
ATSINon-ATSI
Language spoken at home *
Interpreter required *
YesNo
Diagnosis: (if any) *
Any special access needs? (access, visual, hearing impairment) *
Are you registering as a group? *
Registering as an Individual? *
How many people are registering in this group? *
Which organisation? *
Name of Support worker *
Organisation *
Mobile *
Email Address*
Contact Person *
Role/Relationship *
Referring Contact *
Phone *
Email*
Brief description of learning and communication needs of person *
Email : info@birdandbees.com.au
Jodi Rodgers : 0422371331