Carer Support Group Form Update Dec 2022

Consent for storing submitted data

Yes, I give permission to store, process and publish my data on Carers Victoria website.
No, I don't consent to storing, processing or publishing my data

Name of your group

ORG ID

Contact person phone number (for Carers Victoria database only)

Contact person email address (for Carers Victoria database only)

Group Information (for Carers Victoria database only)

Introduction paragraph about your group (maximum 100 words)

Meeting day

Meeting time

Who is this group for?

What activities does the group undertake throughout the year?

Is there a cost?

Yes
No

If YES, please specify what costs are involved

Can the person I care for attend the Carer Support Group meetings with me?

Yes
No

Support Group Facilitator Name

Support Group Phone Number (if applicable)

Support Group Email Address (if applicable)

Support Group website/social media address (if applicable)

Address Line 1

Address Line 2

Postcode

Does the location where you meet have wheelchair access?

Recaptcha *