Adult Participant Details

Classes you plan to attend (tick all that apply):

    Art ClassBus TripsCommunity LunchCommunity Singing GroupCooking ClassDrop-In Table TennisFolks on Spokes Cycling GroupFrench GouterGardeningKnitting & Crochet CircleMonday MovesRailway Readers Book ClubTai ChiWomen's Table TennisWomen's ExerciseZumba
    If you would like to garden, please indicate your preferred day (Mon / Tue / Thu / Sat):

    Participant Details

    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
    Are you an Aboriginal or Torres Strait Islander?

    How Did You Hear About The Class?

    Photo Consent

    Do you give permission for your photo to be used in promotional materials for Railway House?

    Emergency Information & Consent

    Please list any relevant MEDICAL CONDITIONS or ALLERGIES
    Emergency Contact Name (required)
    Emergency Contact Number (required)

    Privacy

    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.

    Payment

    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.