Singability Registration Form

Step 1 of 4 – Personal Details

Personal Details

Your name(Required)

Name Surname

Date of birth(Required)

Day

Month

Year

How would you describe your gender?

Male

Female

Prefer not to say

Other

Your address(Required)

Street Address Suburb Postcode

How can we reach you?

How can we get in touch?

Your email address(Required)

Your phone(Required)

Preferred method of contact(Required)

About you

This information will ensure we provide the best service possible.

Do you have any health or mobility issues we need to be aware of to enable you to participate safely?(Required)

Yes

Please specify

Are there any behaviors of concern that will affect your safe participation in CLA activities?(Required)

Yes

Please specify

Do you have a current Positive Behavior Support Plan and are you willing to provide a copy to CLA?

Yes

Main Contact Details

I am a CLA participant.

Yes

Main Contact Person(Required)

Myself

Legal Guardian

Service Provider

Name(Required)

Name Surname

Agency

Address(Required)

Same as previous

Street Address Suburb Post Code

Email(Required)

Phone(Required)

Program Information

Singability runs on Mondays from 1.30-3pm (1.5hrs) at 56 Cockburn Road, Albany. Non CLA guests can attend 56 Cockburn Road only during the program times and require a Disability Support Pension Card (DSP) to participate in this program. All participants must be on time to minimise disruptions to the choir.

Agreement(Required)

I have read the program information and agree to the program requirements.

I agree and would like to enrol for 2025.

Image Use

I hereby give CLA permission to use photographs featuring me, taken during the Singability project, for promotional on web, Facebook, print, archival and grant acquittal purposes.

Yes

Declaration

Declaration: I the applicant or representative, declare the above information is correct in all respects at the time of the lodgement and that I am over 18 years. I understand that NON CLA guests must be supported while attending CLA activities. I understand I must adhere to the CLA Code of Conduct while attending CLA activities.

Consent

I agree to the the requirements of this enrolment.

Signature Full Name(Required)

Date(Required)

DD slash MM slash YYYY

This field is for validation purposes and should be left unchanged.