Connect, Coach and Take Charge Sign Up Package

Participant Information Sheet

Thank you for your payment. To finalise your place in a group - please

complete the following questionnaire. You will then receive a confirmation email from Developing Minds.

The information that we collect will be kept for our records. Developing Minds employees follow confidentiality and privacy laws and will not release any of this information. The questionnaire responses will be scored and then de-identified & pooled together so that we can evaluate the effectiveness of the group and plan for future groups.

If you have any questions about the group or questionnaires, please email amy@developingminds.net.au

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* 1. What date and time would you like to complete this online course?

Thursday 19th October - Thursday 23rd November 2023 (6 weeks) 6.30pm-8.00pm

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* 2. Your Details:

Full Name

Address

Suburb

State

Post Code

Email Address

Phone Number

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* 3. Emergency Contact Information

Full Name

Phone Number

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* 4. Ages of Your Children:

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* 5. What are the main concerns you have about your child/children?

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* 6. What are the main reasons you would like to attend this course?

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* 7. We offer a free fortnightly e-newsletter for parents (tips, information and advice about caring for kids and teens). Please select below if you would like to receive this.

I am a parent and would like to receive the e-newsletter.

I am a parent and a professional working with kids/teens and would like to receive the e-newsletter.

No, thank you.

I already receive this.