PLEASE NOTE THAT COMPLETING THIS FORM IS ONLY AN EXPRESSION OF INTEREST IN REGISTERING FOR CLASSES. SOMEONE WILL CALL YOU TO CONFIRM AVAILABILITY. PLEASE CALL 96397918 WITH ANY QUESTIONS.

If you require help completing this form, please reach out to Learning in The Hills at 9639 7918, and a representative will be in touch with you.

First Name *

Last Name *

Address *

Postcode *

Suburb *

Contact Phone Number *

Email address: *

Would you like to be kept up to date about class information via email? *

YesNo

Date of Birth *

Country of Birth *

Main Language Spoken at Home *

Gender *

Do you identify as Aboriginal? *

YesNo

Do you identify as Torres Strait Islander? *

YesNo

Do you have any impairments / conditions / disabilities we should be aware of? *

Emergency Contact Name *

Relationship to you *

Emegency Phone Number *

Do you consent for Hills Community Aid/Learning in The Hills to take and use photographs for promotional purposes ? *

YesNo

If Other please specify

If brochure where from?

Are you attending *

Youth ProgramWorkshopRegular Full Term Course

Please select the course(s) you are interested in

(Our representative from Learning in The Hills will contact you to confirm availability of your preferred course(s))

Mahjong

Tuesday 12:15pm-2:15pmWednesday 12:15pm-2:15pmAny

Patchwork & Quilting

Monday 10:00am-1:00pmFriday 9:30am-12:30pmAny

Soft Furnishing and Upholstery

Wednesday 9:30am-11:45amWednesday 12:15pm-2:15pmAny

Tai Chi Plus

Tuesday (Beginners) 2:00pm-3:00pmWednesday (Experienced) 12:00pm-1:00pmWednesday (Intermediate) 1:30pm-2:30pmAny

Technical Support Sessions

Wednesday 12:00pm-2:00pmFriday 10:00am-1:00pmAny

Uniforms 4 Kids

Tuesday 1:00pm-3:00pm

Walking Group

Monday 9:30am-10:30amWednesday 9:30am-10:30amAny

Yoga

Monday (General) 11:00am-12:00pmWednesday (Beginners) 9:30am-10:30amFriday (Experienced) 9:30am-10:30amAny

Please choose the workshop you wish to attend

Youth Week Workshops

Scavenger HuntDrawing with Crystal OnlineRecycled Planter WorkshopEnvironmental Collage Workshop

Workshops for Adults

Holiday Yoga National Carers Week Health and Wellbeing WorkshopsStaying Safe Online Workshop with the PoliceRetro Music and Memorabilia Quiz

CONSENT
The information you provide on this form includes your personal information. Your personal information is protected by law, including by the Commonwealth Privacy Act. We are using an IT system called the ‘Data Exchange’ to store your information. This system is hosted by the Australian Government Department of Social Services (DSS). The personal information that is stored on the Data Exchange is only disclosed to us for the purpose of managing your case.
You do not have to consent to sharing your personal information with DSS. If you do not consent to us sharing your personal information, it will not affect the services you receive. If you do consent to sharing your personal information with DSS, you can ask for this information to be removed at any time. DSS de-identifies your data. This means they remove information that identifies you or that could be used to re-identify you (e.g. your name).
DSS combine your data with other clients’ data in the Data Exchange to identify trends at the program level. This information is used to develop policy, administer grants programs, and conduct research and evaluations. DSS may use this data to produce reports. These reports may be shared with other organisations. The data in these reports is de-identified.
You can find more information about how DSS will manage your personal information in the DSS privacy policy on their website.

Please call the Learning in The Hills co-ordinator on 9639 7918 if you need furthe clarification.

*

Do you consent to collect this information for reporting purposes to the Department of Social Services Data Exchange (DS)? *

YesNo

Do you consent to future contact from Department of Social Services Data Exchange(DS) for survey / research / evaluations? *

YesNo

Terms and Conditions

I acknowledge that it is my responsibility to practice within my own limits and capabilities, to prevent any injury.
I expressly waive any claims I may have against Hills Community Aid for any injury or loss sustained by me while undertaking any classes.
I understand that there is no child minding on site and children are not to be taken to classes.
I understand that Learning in The Hills reserves the right to cancel any course due to insufficient student enrolments, Government requirements or similar.
If I am unwell, I am aware not to come to class.
I understand that Learning in The Hills is required to adhere to requirements of NSW Health and students will be expected to do the same when attending classes.
I understand that Learning in The Hills students are expected to comply with safe work practices outlined above and may be asked to leave class if they do not agree to do so.
Other than our Youth Program, enrolments in our main courses are generally open to people over the age of 16. People under the age of 16 who want to enrol should contact the office to discuss the request.

I acknowledge that I have read and understood the above statements. *

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