Expression of Interest Registration

About You

Please complete this 5 minute survey to register your interest in attending CaPSS' programs. *Please note that in-person programs are held within the Cities of Melton and Wyndham.

The Salvation Army is committed to caring for people by protecting personal information and upholding the Australian Privacy Principles. To read our privacy policy please visit salvationarmy.org.au/privacy. By providing us with your personal information or by using the website, you are confirming your agreement to the content of our privacy policy.

Note: if you would like to register interest on someone else's behalf, please email capss@salvationarmy.org.au to ask for a referral form.

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* 1. What is your First Name?

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* 2. What is your Last Name?

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* 3. Gender

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* 4. What is your address?

Address Line 1

Address Line 2

Suburb

State

Postcode

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* 5. Email address and phone number (for links and reminders)

Email Address

Phone Number

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* 6. How do you prefer to be contacted?

Phone call

Text message

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* 7. When is the best time and day to contact you (between the hours of 9 am - 5 pm Monday to Friday)?

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* 8. What is your date of birth?

Date

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* 9. Do you identify as either Aboriginal or Torres Strait Islander

Aboriginal

Torres Strait Islander

Both Aboriginal and Torres Strait Islander

Neither

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* 10. Were you born in Australia?

Yes