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Social Support Group Application Form

If you require clarification or assistance with any questions, please call 1300 699 622.

Enrolment Process

  1. Registered with the Y Inclusion Services
  2. Complete this Application form
  3. Support Coordinator will send a Service Agreement listing all NDIS fees and Confirmation of successful enrolment to program (your place on the program is pending a signed of Service Agreement be returned).

If there is a day/night you will not be attending the program you are enrolled in, you can opt out. Please let us know if you wish to opt out of any date by emailing or by phoning 1300 699 622.

This application form is used to register your interest in the upcoming social support groups offered by the Y.

PRIVACY STATEMENT The YMCA acknowledges and respects the privacy of individuals. The information that is being collected on this document is for the purposes of processing your membership or enrolment and financial institution payments if applicable. The YMCA, its authorised staff and contracted service providers such as financial institutions and Government agencies covered by law, may be recipients of this information. By joining or enrolling in a program at the local Centre you have also become a member of the YMCA. You will receive communications from the YMCA from time to time to update you on items relating to your membership. The YMCA uses a range of mediums to communicate with its members including, but not exclusive to, direct mail, email, SMS and telephone. If sent by mail, communications are taken to be received on the day that they would be received in the ordinary course of post. If you do not wish to have your information contained in this document used or disclosed for this purpose the YMCA will be unable to process your membership or enrolment. You have the right to access and alter personal information protecting yourself in accordance with the Commonwealth Privacy Act (Amended 2001). The Privacy Policy is available on the YMCA Whittlesea website.