Auspice Programs

Walk, Talk & Connect

Walk, Talk & Connect is a friendly and inclusive walking group held every Thursday morning at Mill Park Community House. Open to people of all ages and abilities, the group provides a wonderful opportunity to enjoy gentle exercise, improve physical and mental wellbeing, and connect with others in a welcoming community environment.

Participants meet at the Community House before heading out for a relaxed walk around the local area (weather permitting). Following the walk, everyone is invited back to enjoy tea, coffee, and biscuits while catching up, making new friendships, and strengthening community connections.

Whether you’re looking to stay active, meet new people, or simply enjoy some fresh air and good company, Walk, Talk & Connect is a great way to start your Thursday morning.

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Walk, Talk & Connect

Please fill out the enrolment form below,

or click here to download the printable enrolment form.

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Course/Program Title(Required)

Term(Required)

Funding Source

Self

Agency

Agency Name(Required)

Agency Contact Details(Required)

How did you hear about us?

Student Details

Gender(Required)

Male

Female

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Telephone

Mobile(Required)

Email Address(Required)

Date of birth(Required)

DD slash MM slash YYYY

CRN Number

Identify Origin

Aboriginal

Torres Strait Island origin

Neither

Country of birth(Required)

Town Born in

Language spoken at home

How well is English spoken?

Very Well

Well

Not well

Not well at all

Disability, impairment or long term condition

Yes

Which areas

Hearing/Deaf

Physical

Intellectual

Learning

Mental Illness

Acquired Brain Injury

Vision

Medical Illness

Other

Previous further Education

Are you still attending secondary school(Required)

Yes

School Level – Year(Required)

Year Completed

Previous qualifications achieved

Bachelor Degree or Higher Degree

Advanced Diploma or Associate Degree

Diploma (or Associate Diploma)

Certificate IV (or Advanced Certificate/Technician

Certificate III (or Trade Certificate)

Certificate II

Certificate I

Certificates other than the above

Employment

Unemployed - Seeking full

Unemployed – seeking part-time

Self-employed – not employing others

Employer

Employed - unpaid worker in family business

Not employed – not seeking employment

Reason for Study

To get a job

To develop my existing business

To start my own business

Change of career

To get a better job or promotion

It was requirement of my job

To get into another course of study

For personal interest or self-development

Other reasons

STUDENT SCHOOL ATTENDANCE STATUS DECLARATION

Student Declaration: I, (Enter your full name)(Required)

In seeking to enroll in: (Enter the full title of course)(Required)

Declare the following to be true and accurate:

I AM NOT enrolled in a school, including government, non-government, Catholic, or home school, and I am aged:
- Over 17 years of age, or
- Under17 years of age and have provided Evidence of Exemption by a school principal or Education and Training Regional Director.
I acknowledge and understand that I may be contacted by the Department of Education and Training or an agent to participate in a survey, interview, or other questionnaire.

SIGNED (type your full name)(Required)

Date

DD slash MM slash YYYY

TRAINING PROVIDER DECLARATION:

Based on discussion with the student, the above evidence I have sighted (and retained a copy of) in Sections A, B and this form I believe that the above individual satisfies the eligibility criteria set out in 2022 Training Delivery Guidelines.

Walk, Talk & Connect

Please fill out the form below,

or click here to download the printable expression of interest form.

This field is hidden when viewing the form

Course/Program Title(Required)

Title(Required)

Mrs

Miss

Name(Required)

First Last

Name Used (if different from above)

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Phone(Required)

Email(Required)

Date of birth(Required)

DD slash MM slash YYYY

Date Joined

DD slash MM slash YYYY

Next of Kin (In case of emergency)

Relationship (Son/Daughter etc)

Phone No

Do you consent to your Photograph being taken for advertising and social media purposes?

Yes

Do you consent to a medical practitioner, hospital or ambulance service to be contacted if required on the day of attendance at the group?

Yes

Wednesday Seniors Group

Join our friendly Wednesday Seniors Social Group and enjoy a relaxed and welcoming environment where you can meet new people, make friends, and stay socially connected.

Each week, participants come together to enjoy a range of fun activities including bingo, raffles, prizes, social games, and friendly conversation. Tea, coffee, and cake are provided, creating the perfect opportunity to relax, socialise, and enjoy the company of others.

Our group is a great way to get out of the house, reduce social isolation, and participate in enjoyable community activities. Throughout the year, members may also enjoy special lunches, celebrations, guest speakers, and other social events.

Entry is just $4 per person, making it an affordable and enjoyable way to spend time with friends and connect with the local community.

Whether you’re looking to make new friends, enjoy a game of bingo, or simply share a coffee and chat, our Wednesday Seniors Social Group offers a warm and supportive community where everyone is welcome.

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Wednesday Seniors Group

Please fill out the enrolment form below,

or click here to download the printable enrolment form.

This field is hidden when viewing the form

Course/Program Title(Required)

Term(Required)

Funding Source

Self

Agency

Agency Name(Required)

Agency Contact Details(Required)

How did you hear about us?

Student Details

Gender(Required)

Male

Female

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Telephone

Mobile(Required)

Email Address(Required)

Date of birth(Required)

DD slash MM slash YYYY

CRN Number

Identify Origin

Aboriginal

Torres Strait Island origin

Neither

Country of birth(Required)

Town Born in

Language spoken at home

How well is English spoken?

Very Well

Well

Not well

Not well at all

Disability, impairment or long term condition

Yes

Which areas

Hearing/Deaf

Physical

Intellectual

Learning

Mental Illness

Acquired Brain Injury

Vision

Medical Illness

Other

Previous further Education

Are you still attending secondary school(Required)

Yes

School Level – Year(Required)

Year Completed

Previous qualifications achieved

Bachelor Degree or Higher Degree

Advanced Diploma or Associate Degree

Diploma (or Associate Diploma)

Certificate IV (or Advanced Certificate/Technician

Certificate III (or Trade Certificate)

Certificate II

Certificate I

Certificates other than the above

Employment

Unemployed - Seeking full

Unemployed – seeking part-time

Self-employed – not employing others

Employer

Employed - unpaid worker in family business

Not employed – not seeking employment

Reason for Study

To get a job

To develop my existing business

To start my own business

Change of career

To get a better job or promotion

It was requirement of my job

To get into another course of study

For personal interest or self-development

Other reasons

STUDENT SCHOOL ATTENDANCE STATUS DECLARATION

Student Declaration: I, (Enter your full name)(Required)

In seeking to enroll in: (Enter the full title of course)(Required)

Declare the following to be true and accurate:

I AM NOT enrolled in a school, including government, non-government, Catholic, or home school, and I am aged:
- Over 17 years of age, or
- Under17 years of age and have provided Evidence of Exemption by a school principal or Education and Training Regional Director.
I acknowledge and understand that I may be contacted by the Department of Education and Training or an agent to participate in a survey, interview, or other questionnaire.

SIGNED (type your full name)(Required)

Date

DD slash MM slash YYYY

TRAINING PROVIDER DECLARATION:

Wednesday Seniors Group

Please fill out the form below,

or click here to download the printable expression of interest form.

This field is hidden when viewing the form

Course/Program Title(Required)

Title(Required)

Mrs

Miss

Name(Required)

First Last

Name Used (if different from above)

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Phone(Required)

Email(Required)

Date of birth(Required)

DD slash MM slash YYYY

Date Joined

DD slash MM slash YYYY

Next of Kin (In case of emergency)

Relationship (Son/Daughter etc)

Phone No

Do you consent to your Photograph being taken for advertising and social media purposes?

Yes

Do you consent to a medical practitioner, hospital or ambulance service to be contacted if required on the day of attendance at the group?

Yes

Coffee & Chat

Our Coffee & Chat program offers a relaxed and welcoming space for people to come together, connect, and enjoy meaningful conversation. Open to anyone in the community, participants are invited to socialise, share experiences, and connect with like-minded people in a safe and friendly environment.

The group meets every Thursday from 1:00 PM to 3:00 PM at Mill Park Community House. Tea, coffee, cakes, and biscuits are provided, and there is a $2 session cost.

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Enrol Now

Coffee & Chat

Please fill out the enrolment form below,

or click here to download the printable enrolment form.

This field is hidden when viewing the form

Course/Program Title(Required)

Term(Required)

Funding Source

Self

Agency

Agency Name(Required)

Agency Contact Details(Required)

How did you hear about us?

Student Details

Gender(Required)

Male

Female

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Telephone

Mobile(Required)

Email Address(Required)

Date of birth(Required)

DD slash MM slash YYYY

CRN Number

Identify Origin

Aboriginal

Torres Strait Island origin

Neither

Country of birth(Required)

Town Born in

Language spoken at home

How well is English spoken?

Very Well

Well

Not well

Not well at all

Disability, impairment or long term condition

Yes

Which areas

Hearing/Deaf

Physical

Intellectual

Learning

Mental Illness

Acquired Brain Injury

Vision

Medical Illness

Other

Previous further Education

Are you still attending secondary school(Required)

Yes

School Level – Year(Required)

Year Completed

Previous qualifications achieved

Bachelor Degree or Higher Degree

Advanced Diploma or Associate Degree

Diploma (or Associate Diploma)

Certificate IV (or Advanced Certificate/Technician

Certificate III (or Trade Certificate)

Certificate II

Certificate I

Certificates other than the above

Employment

Unemployed - Seeking full

Unemployed – seeking part-time

Self-employed – not employing others

Employer

Employed - unpaid worker in family business

Not employed – not seeking employment

Reason for Study

To get a job

To develop my existing business

To start my own business

Change of career

To get a better job or promotion

It was requirement of my job

To get into another course of study

For personal interest or self-development

Other reasons

STUDENT SCHOOL ATTENDANCE STATUS DECLARATION

Student Declaration: I, (Enter your full name)(Required)

In seeking to enroll in: (Enter the full title of course)(Required)

Declare the following to be true and accurate:

I AM NOT enrolled in a school, including government, non-government, Catholic, or home school, and I am aged:
- Over 17 years of age, or
- Under17 years of age and have provided Evidence of Exemption by a school principal or Education and Training Regional Director.
I acknowledge and understand that I may be contacted by the Department of Education and Training or an agent to participate in a survey, interview, or other questionnaire.

SIGNED (type your full name)(Required)

Date

DD slash MM slash YYYY

TRAINING PROVIDER DECLARATION:

Coffee & Chat

Please fill out the form below,

or click here to download the printable expression of interest form.

This field is hidden when viewing the form

Course/Program Title(Required)

Title(Required)

Mrs

Miss

Name(Required)

First Last

Name Used (if different from above)

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Phone(Required)

Email(Required)

Date of birth(Required)

DD slash MM slash YYYY

Date Joined

DD slash MM slash YYYY

Next of Kin (In case of emergency)

Relationship (Son/Daughter etc)

Phone No

Do you consent to your Photograph being taken for advertising and social media purposes?

Yes

Do you consent to a medical practitioner, hospital or ambulance service to be contacted if required on the day of attendance at the group?

Yes

Carers Friendship Group (M.I.)

Our Carer’s Friendship Group is for families and friends of people living with mental illness. The group provides a supportive and welcoming environment where carers can connect with others who understand their experiences, share stories, and access practical information and resources.

The group aims to reduce isolation, build friendships, and offer emotional support for those caring for a loved one with mental illness, while fostering a sense of community and understanding.

The group meets from 12:30 PM to 3:00 PM on the fourth Wednesday of each month.

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Enrol Now

Carers Friendship Group (M.I.)

Please fill out the enrolment form below,

or click here to download the printable enrolment form.

This field is hidden when viewing the form

Course/Program Title(Required)

Term(Required)

Funding Source

Self

Agency

Agency Name(Required)

Agency Contact Details(Required)

How did you hear about us?

Student Details

Gender(Required)

Male

Female

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Telephone

Mobile(Required)

Email Address(Required)

Date of birth(Required)

DD slash MM slash YYYY

CRN Number

Identify Origin

Aboriginal

Torres Strait Island origin

Neither

Country of birth(Required)

Town Born in

Language spoken at home

How well is English spoken?

Very Well

Well

Not well

Not well at all

Disability, impairment or long term condition

Yes

Which areas

Hearing/Deaf

Physical

Intellectual

Learning

Mental Illness

Acquired Brain Injury

Vision

Medical Illness

Other

Previous further Education

Are you still attending secondary school(Required)

Yes

School Level – Year(Required)

Year Completed

Previous qualifications achieved

Bachelor Degree or Higher Degree

Advanced Diploma or Associate Degree

Diploma (or Associate Diploma)

Certificate IV (or Advanced Certificate/Technician

Certificate III (or Trade Certificate)

Certificate II

Certificate I

Certificates other than the above

Employment

Unemployed - Seeking full

Unemployed – seeking part-time

Self-employed – not employing others

Employer

Employed - unpaid worker in family business

Not employed – not seeking employment

Reason for Study

To get a job

To develop my existing business

To start my own business

Change of career

To get a better job or promotion

It was requirement of my job

To get into another course of study

For personal interest or self-development

Other reasons

STUDENT SCHOOL ATTENDANCE STATUS DECLARATION

Student Declaration: I, (Enter your full name)(Required)

In seeking to enroll in: (Enter the full title of course)(Required)

Declare the following to be true and accurate:

I AM NOT enrolled in a school, including government, non-government, Catholic, or home school, and I am aged:
- Over 17 years of age, or
- Under17 years of age and have provided Evidence of Exemption by a school principal or Education and Training Regional Director.
I acknowledge and understand that I may be contacted by the Department of Education and Training or an agent to participate in a survey, interview, or other questionnaire.

SIGNED (type your full name)(Required)

Date

DD slash MM slash YYYY

TRAINING PROVIDER DECLARATION:

Carers Friendship Group (M.I.)

Please fill out the form below,

or click here to download the printable expression of interest form.

This field is hidden when viewing the form

Course/Program Title(Required)

Title(Required)

Mrs

Miss

Name(Required)

First Last

Name Used (if different from above)

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Phone(Required)

Email(Required)

Date of birth(Required)

DD slash MM slash YYYY

Date Joined

DD slash MM slash YYYY

Next of Kin (In case of emergency)

Relationship (Son/Daughter etc)

Phone No

Do you consent to your Photograph being taken for advertising and social media purposes?

Yes

Do you consent to a medical practitioner, hospital or ambulance service to be contacted if required on the day of attendance at the group?

Yes

Recycled Teenagers Group

The Mill Park Recycled Teenagers group is a welcoming space for seniors to socialise, connect with others, and enjoy a variety of fun activities. The group meets every Tuesday from 12:00 PM to 3:00 PM.

Members enjoy activities such as group lunches, bingo, card games, guest speakers, and movie afternoons. The group provides a friendly and inclusive environment where seniors can make new friends, stay engaged, and have fun.

Annual cost: $10

Download Brochure

Enrol Now

Recycled Teenagers Group

Please fill out the enrolment form below,

or click here to download the printable enrolment form.

This field is hidden when viewing the form

Course/Program Title(Required)

Term(Required)

Funding Source

Self

Agency

Agency Name(Required)

Agency Contact Details(Required)

How did you hear about us?

Student Details

Gender(Required)

Male

Female

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Telephone

Mobile(Required)

Email Address(Required)

Date of birth(Required)

DD slash MM slash YYYY

CRN Number

Identify Origin

Aboriginal

Torres Strait Island origin

Neither

Country of birth(Required)

Town Born in

Language spoken at home

How well is English spoken?

Very Well

Well

Not well

Not well at all

Disability, impairment or long term condition

Yes

Which areas

Hearing/Deaf

Physical

Intellectual

Learning

Mental Illness

Acquired Brain Injury

Vision

Medical Illness

Other

Previous further Education

Are you still attending secondary school(Required)

Yes

School Level – Year(Required)

Year Completed

Previous qualifications achieved

Bachelor Degree or Higher Degree

Advanced Diploma or Associate Degree

Diploma (or Associate Diploma)

Certificate IV (or Advanced Certificate/Technician

Certificate III (or Trade Certificate)

Certificate II

Certificate I

Certificates other than the above

Employment

Unemployed - Seeking full

Unemployed – seeking part-time

Self-employed – not employing others

Employer

Employed - unpaid worker in family business

Not employed – not seeking employment

Reason for Study

To get a job

To develop my existing business

To start my own business

Change of career

To get a better job or promotion

It was requirement of my job

To get into another course of study

For personal interest or self-development

Other reasons

STUDENT SCHOOL ATTENDANCE STATUS DECLARATION

Student Declaration: I, (Enter your full name)(Required)

In seeking to enroll in: (Enter the full title of course)(Required)

Declare the following to be true and accurate:

I AM NOT enrolled in a school, including government, non-government, Catholic, or home school, and I am aged:
- Over 17 years of age, or
- Under17 years of age and have provided Evidence of Exemption by a school principal or Education and Training Regional Director.
I acknowledge and understand that I may be contacted by the Department of Education and Training or an agent to participate in a survey, interview, or other questionnaire.

SIGNED (type your full name)(Required)

Date

DD slash MM slash YYYY

TRAINING PROVIDER DECLARATION:

Recycled Teenagers Group

Please fill out the form below,

or click here to download the printable expression of interest form.

This field is hidden when viewing the form

Course/Program Title(Required)

Title(Required)

Mrs

Miss

Name(Required)

First Last

Name Used (if different from above)

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Phone(Required)

Email(Required)

Date of birth(Required)

DD slash MM slash YYYY

Date Joined

DD slash MM slash YYYY

Next of Kin (In case of emergency)

Relationship (Son/Daughter etc)

Phone No

Do you consent to your Photograph being taken for advertising and social media purposes?

Yes

Do you consent to a medical practitioner, hospital or ambulance service to be contacted if required on the day of attendance at the group?

Yes

Neuro Club

The Neuro Club is a social group for people with a neurological disability, providing a welcoming space for socialising, companionship, and participation in planned activities. The group meets every Monday and Friday.

Occasionally, the group also goes on outings to places such as the movies, cafés, or museums, giving members the chance to explore the community and enjoy new experiences.

The venue is wheelchair accessible and includes disability toilet facilities. Participants bring their own lunch, though occasionally lunch may be provided.

Cost: $2 per session (covers tea and coffee)
Annual Membership Fee: $10

Download Brochure

Enrol Now

Neuro Club

Please fill out the enrolment form below,

or click here to download the printable enrolment form.

This field is hidden when viewing the form

Course/Program Title(Required)

Term(Required)

Funding Source

Self

Agency

Agency Name(Required)

Agency Contact Details(Required)

How did you hear about us?

Student Details

Gender(Required)

Male

Female

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Telephone

Mobile(Required)

Email Address(Required)

Date of birth(Required)

DD slash MM slash YYYY

CRN Number

Identify Origin

Aboriginal

Torres Strait Island origin

Neither

Country of birth(Required)

Town Born in

Language spoken at home

How well is English spoken?

Very Well

Well

Not well

Not well at all

Disability, impairment or long term condition

Yes

Which areas

Hearing/Deaf

Physical

Intellectual

Learning

Mental Illness

Acquired Brain Injury

Vision

Medical Illness

Other

Previous further Education

Are you still attending secondary school(Required)

Yes

School Level – Year(Required)

Year Completed

Previous qualifications achieved

Bachelor Degree or Higher Degree

Advanced Diploma or Associate Degree

Diploma (or Associate Diploma)

Certificate IV (or Advanced Certificate/Technician

Certificate III (or Trade Certificate)

Certificate II

Certificate I

Certificates other than the above

Employment

Unemployed - Seeking full

Unemployed – seeking part-time

Self-employed – not employing others

Employer

Employed - unpaid worker in family business

Not employed – not seeking employment

Reason for Study

To get a job

To develop my existing business

To start my own business

Change of career

To get a better job or promotion

It was requirement of my job

To get into another course of study

For personal interest or self-development

Other reasons

STUDENT SCHOOL ATTENDANCE STATUS DECLARATION

Student Declaration: I, (Enter your full name)(Required)

In seeking to enroll in: (Enter the full title of course)(Required)

Declare the following to be true and accurate:

I AM NOT enrolled in a school, including government, non-government, Catholic, or home school, and I am aged:
- Over 17 years of age, or
- Under17 years of age and have provided Evidence of Exemption by a school principal or Education and Training Regional Director.
I acknowledge and understand that I may be contacted by the Department of Education and Training or an agent to participate in a survey, interview, or other questionnaire.

SIGNED (type your full name)(Required)

Date

DD slash MM slash YYYY

TRAINING PROVIDER DECLARATION:

Neuro Club

Please fill out the form below,

or click here to download the printable expression of interest form.

This field is hidden when viewing the form

Course/Program Title(Required)

Title(Required)

Mrs

Miss

Name(Required)

First Last

Name Used (if different from above)

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Phone(Required)

Email(Required)

Date of birth(Required)

DD slash MM slash YYYY

Date Joined

DD slash MM slash YYYY

Next of Kin (In case of emergency)

Relationship (Son/Daughter etc)

Phone No

Do you consent to your Photograph being taken for advertising and social media purposes?

Yes

Do you consent to a medical practitioner, hospital or ambulance service to be contacted if required on the day of attendance at the group?

Yes

Mill Park Garden Club

The Mill Park Garden Club is a welcoming group for seniors who enjoy gardening, socialising, and community involvement. Members have been maintaining the cottage garden, orchard, and car park at Hawkstowe Picnic Area since the voluntary project began with Parks Victoria in 1994.

The club meets from 12:30 PM to 3:00 PM on the third Friday of each month. Activities include:

Monthly meetings with guest speakers
Mini show table, selling table, and library
Monthly trips to visit gardens and nurseries
Special fundraising days
Volunteer days maintaining the cottage garden and orchard
Working bees and monthly sausage sizzles

The club provides a friendly and social environment where seniors can connect with others, share their love of gardening, and participate in hands-on activities.

Download Brochure

Enrol Now

Mill Park Garden Club

Please fill out the enrolment form below,

or click here to download the printable enrolment form.

This field is hidden when viewing the form

Course/Program Title(Required)

Term(Required)

Funding Source

Self

Agency

Agency Name(Required)

Agency Contact Details(Required)

How did you hear about us?

Student Details

Gender(Required)

Male

Female

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Telephone

Mobile(Required)

Email Address(Required)

Date of birth(Required)

DD slash MM slash YYYY

CRN Number

Identify Origin

Aboriginal

Torres Strait Island origin

Neither

Country of birth(Required)

Town Born in

Language spoken at home

How well is English spoken?

Very Well

Well

Not well

Not well at all

Disability, impairment or long term condition

Yes

Which areas

Hearing/Deaf

Physical

Intellectual

Learning

Mental Illness

Acquired Brain Injury

Vision

Medical Illness

Other

Previous further Education

Are you still attending secondary school(Required)

Yes

School Level – Year(Required)

Year Completed

Previous qualifications achieved

Bachelor Degree or Higher Degree

Advanced Diploma or Associate Degree

Diploma (or Associate Diploma)

Certificate IV (or Advanced Certificate/Technician

Certificate III (or Trade Certificate)

Certificate II

Certificate I

Certificates other than the above

Employment

Unemployed - Seeking full

Unemployed – seeking part-time

Self-employed – not employing others

Employer

Employed - unpaid worker in family business

Not employed – not seeking employment

Reason for Study

To get a job

To develop my existing business

To start my own business

Change of career

To get a better job or promotion

It was requirement of my job

To get into another course of study

For personal interest or self-development

Other reasons

STUDENT SCHOOL ATTENDANCE STATUS DECLARATION

Student Declaration: I, (Enter your full name)(Required)

In seeking to enroll in: (Enter the full title of course)(Required)

Declare the following to be true and accurate:

I AM NOT enrolled in a school, including government, non-government, Catholic, or home school, and I am aged:
- Over 17 years of age, or
- Under17 years of age and have provided Evidence of Exemption by a school principal or Education and Training Regional Director.
I acknowledge and understand that I may be contacted by the Department of Education and Training or an agent to participate in a survey, interview, or other questionnaire.

SIGNED (type your full name)(Required)

Date

DD slash MM slash YYYY

TRAINING PROVIDER DECLARATION:

Mill Park Garden Club

Please fill out the form below,

or click here to download the printable expression of interest form.

This field is hidden when viewing the form

Course/Program Title(Required)

Title(Required)

Mrs

Miss

Name(Required)

First Last

Name Used (if different from above)

Address(Required)

Street Address Address Line 2 Suburb State Post Code Country

Phone(Required)

Email(Required)

Date of birth(Required)

DD slash MM slash YYYY

Date Joined

DD slash MM slash YYYY

Next of Kin (In case of emergency)

Relationship (Son/Daughter etc)

Phone No

Do you consent to your Photograph being taken for advertising and social media purposes?

Yes

Do you consent to a medical practitioner, hospital or ambulance service to be contacted if required on the day of attendance at the group?

Yes

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Got questions?

Please fill out the form below, or feel free to give us a call on 03 9404 4565.

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