10 Cometrowe Street, Drummoyne 2047 Telephone: 9719-8102

DRUMMOYNE COMMUNITY CENTRE (DCC)

10 Cometrowe Street, Drummoyne 2047 Telephone: 9719-8102

Parenting Enrolment Form Term 4, 2017

This form can be completed in Word and then emailed to

First Attendee:

Surname / First Name
Gender: / Male / Female
Age Category: / Under 25 / 26-35 / 36-45 / 46-55 / 56+
Email
Phone: Home / Work / Mobile

Second Attendee:

Surname / First Name
Gender: / Male / Female
Age Category: / Under 25 / 26-35 / 36-45 / 46-55 / 56+
Email
Phone: Home / Work / Mobile
Address
Suburb / Postcode
Emergency Contact Name / Emergency Contact Phone
Relationship to you
Course Name & Date / Select / Fee (Negotiable) / Receipt No.
Circle of Security: (Parents/carers of children up to 7yrs)
Tuesdays 10 Oct to 14 Nov 2017, 7pm to9pm / $11 DCC Membership per person
Getting to Know Your Baby (Parents & babies 0 to 13mths)
Fridays 20 & 27 Oct; 10, 17 & 24 Nov, 11am to 12pm / $25
+ $11 DCC Membership pp
Caring for Kids First Aid
Sunday 5 November, 9am to 5pm / $40 pp or $60 per couple
+ $11 DCC Membership pp
What do you hope to gain from attending the program?
What are the gender and ages of your children or grandchildren?
Gender/name / Date of birth / Gender/name / Date of birth

Ethnicity:

Are you of Aboriginal or Torres Strait Island origin? / 1st Attendee / No / Yes / 2nd Attendee / No / Yes
Country of Birth? / 1st Attendee / 2nd Attendee
How long have you been in Australia? / 1st Attendee / 2nd Attendee
Language spoken at home? / 1st Attendee / 2nd Attendee

Disability:(Circle/highlight answer)

1st Attendee / Do you consider you have any disabilities? / No / Yes, specify
2ndAttendee / Do you consider you have any disabilities? / No / Yes, specify

Employment:Which of the following would best describe your current work status? (Circle/highlight answer)

1st Attendee / Full time employee / Self employed / Seeking work / Not seeking work (eg retired)
Part time employee / Unpaid family worker / Employer / Student
2nd Attendee / Full time employee / Self employed / Seeking work / Not seeking work (eg retired)
Part time employee / Unpaid family worker / Employer / Student

Education:What is the highest level of your education?(Circle/highlight your answer)

1st Attendee / Primary / Secondary / Tertiary
Have you completed any TAFE or university courses? / No / Yes, specify
2nd Attendee / Primary / Secondary / Tertiary
Have you completed any TAFE or university courses? / No / Yes, specify

Where did you hear about our courses?(Circle/highlight your answer)

DCC Brochure / Flyer / Resourcing Parents Website / Word of mouth / Other, specify

No refunds for courses unless courses cancelled.

Signature: ______Date: ______

Method of Payment:Payment can be made at the Drummoyne Community Centre office on weekdays between 9:30am and 4pm. Payment can be by cash, cheque or by direct transfer into DCC bank account – contact office for BSB / account details.

Z:\Parenting Programs\2017\enrolment forms\Parenting enrolment form T4 17.doc