ADHD Enrolment Form

ADHD Parent Education and Support Group Enrolment Form

ADHD Parent Education and Support Group - Learn about the ADHD brain; strategies to try at home and school, and learn from each other’s experiences in a small group, with lots of videos and discussions.

Please complete an individual enrolment form for each parent or legal guardian wishing to attend.

Where did you hear about BUSHkids services?

Parent / Legal Guardian Information

First Name *

Surname *

Parent/Legal Guardian DOB *

Parent/Legal Gender *

Contact Number *

Email Address *A copy of this completed form will be emailed to you upon submission. Please double check and ensure your email address is entered correctly to avoid this information being delivered to an incorrect email address.

Address *

Street address *

City *

State *

Postcode *

What country were you born in?

Do you have any known disability or significant medical history?

Information provided below assists us with our cultural awareness policy and reporting requirements.

Are you of Aboriginal, Torres Strait or South Sea Islander origin? *

Other (Please specify)

Do you speak any language other than English at home? *

YesNo

If yes, which language:

Do you identify as Culturally and Linguistically Diverse (CALD)?

YesNo

CALD: A person born or has parent/s born in a non-English speaking country, and/or who does not speak English at home.

Is your child currently receiving support through the National Disability Insurance Scheme (NDIS)?

YesNo

Parent / Legal Guardian Consent

I consent and I am happy for photographs and/or video recording to be taken of myself to be used by BUSHkids; to share on social media – Facebook or for use in media such as BUSHkids Annual Report.

YesNo

By signing below I consent to/acknowledge:

Partipating in the ADHD Parent Education and Support group Program
The collection of personal information from and for persons named on this form for BUSHkids records
It is my responsibility to contact BUSHkids if further assistance is required once the Group Program is completed

If you would like to discuss any of these options with BUSHkids, please reach out either by emailing Healthyoutbackkids@bushkids.org.au or phoning 07 4743 2575.

Parent/ Legal Guardian Signature *

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