Classes you plan to attend (tick all that apply):
Cards - CanastaCards - 500Art ClassBook ClubBus TripsChess ClubFood & CookingCommunity Singing GroupTable TennisCycling GroupFrench GouterGardeningKnitting & Crochet CircleMonday MovesPilates for BeginnersTai Chi (Monday)Women's Table TennisWomen's ExerciseHorticulture Course - Term 4
If you would like to join our gardening groups, please indicate your preferred day (Mon / Tue / Thu / Sat):
First Name (required)
Last Name (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.
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
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.