Workshop Registration Form

Name

Workshop Date

Workshop Location

E-Mail *

Address

Phone/Mob

New to Care Matters?

How did you find out about us?

What do you want to learn from attending?

In what capacity are you attending?

Age Group

Ethnicity

Other (please state)

What is the main type of disability the person you live with/care for has?

Other (please describe)

What is the age of the person being cared for?

Do you have any additional support or learning needs (please describe)?

Do you or your family member qualify for disability support services through the Needs Assessment Agency?

Would you like Care Matters to inform you about other workshops in your area?

Do you have any dietary needs (please describe)?

2 + 0 = ?Please prove that you are human by solving the equation *

Thank you