Classes you plan to attend (tick all that apply):
Art ClassBook ClubBus TripsCards - CanastaCards - 500Community Singing GroupCompost ClubCycling GroupFood In CommonFrench Conversation - BeginnersFrench Conversation - IntermediateFrench Conversation - Int. to AdvancedGardening*German ConversationKnitting & Crochet CircleMeditationPilates - ChairPilates - MatScrabble ClubStrength Training - MondayStrength Training - FridayTable Tennis - CompetitiveTai Chi - BeginnersTai Chi - ContinuingTable Tennis - SocialWomen's Exercise
*If you would like to join a gardening group, please indicate your preferred day (Mon / Tue / Thu / Sat):
First Name (required)
Last Name (required)
Address (required)
Suburb (required)
Postcode (required)
Email (required)
Contact Number (required)
Main Language Spoken at Home
Healthcare Card Holder YesNo
Are you an Aboriginal or Torres Strait Islander? YesNo
BrochureRailway HouseWord of MouthOther (please specify below)
Do you give permission for your photo to be used in promotional materials for Railway House? YesNo
Please list any relevant MEDICAL CONDITIONS or ALLERGIES
Emergency Contact Name (required)
Emergency Contact Number (required)
I give permission for the staff of NCRNH to seek emergency Medical, Hospital or Ambulance service should the necessity arise and if appropriate administer basic first aid if required. I accept liability for any expenses incurred should medical treatment or transport be required.
I agree to abide by the North Carlton Railway Neighbourhood House Code of Conduct.
I understand that Railway House may share my contact details with class tutors where appropriate, for communication purposes only.
All personal information is kept confidential and in accordance with information privacy laws. Please contact us if you would like further details on our privacy policy.
Please contact the office to make your payment (if applicable). The following methods of payment are accepted:
Card (preferred) either in the office or over the phone Cash in the office Bank Transfer
Bank details: Account Name: North Carlton Railway Neighbourhood House BSB: 313 140 Account: 1205 4263
We acknowledge there may be financial barriers for some members of our community in accessing programs for which there is fee. Please talk to staff if this is the case for you. We are committed to ensuring participation by all.
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