City of Monash Switch registration

 The Switch program is a 4 week female only program for any woman who wants to get active in a fun and inclusive environment.
 Switch focuses on the fun and social benefits of Touch football, so you learn a new skill whilst being active.
To be apart of this free program all you need to do is fill in the registration form below 

Program details
Monday nights @ 6:30pm
22-2-2021 till 22-3-2021 (excluding labour day holiday 8th  March)
Address: 27 Power Ave, Ashwood VIC 3147

Please note your non-identifiable data will be provided to LaTrobe University on behalf of VicHealth.

Question Title

* 1. First name

Question Title

* 2. Surname

Question Title

* 3. Email

Question Title

* 4. Phone number

Question Title

* 5. Gender

Question Title

* 6. Date of birth

Question Title

* 7. What is your street address?

Question Title

* 8. What is your postcode

Question Title

* 10. Other than a Medicare card, are you the holder of a health care card or a pensioner concession card? Health care cards are issued by Centrelink and are different to Medicare cards.

Question Title

* 11. Are you the parent or carer of any children in your household? This includes children over 18 years.

Question Title

* 12. Where were you born?

0 of 19 answered
 

T