Carer Wellbeing and Connection Online Program Form

Thank you for your interest in attending the Carer Wellbeing and Connection Online Program

Please complete this form to register your details:

First name and surname *

Suburb - First priority is given to carers living in the North Western Metro region of Melbourne* *

Postcode *

*If you LIVE outside of the North Western Metro Region, please advise of your link to the area (e.g. work, study, visit GP etc)

Mobile/Phone Number *

Email Address *

Please specify which group is your preference

Group A: Beginning 4 June 2024 four Tuesday evening sessions
Group B: Beginning 5 June 2024 four Wednesday morning sessions
GROUP C: Beginning 5 June 2024 four Wednesday afternoon sessions
Group for Bereaved Carers: Beginning 4 June 2024 four Tuesday evening sessions (Bereaved carers only – not less than 3 months)
Future groups

If more than one preference, please specify in number order of your preference of group selection.

Carer Wellbeing and Connection Online Program Form

Carer Wellbeing and Connection Online Program Form

Thank you for your interest in attending the Carer Wellbeing and Connection Online Program

Please complete this form to register your details:

Please note