Registration form

Let's start with your personal details

Emergency Contact Information

Support Person/Worker (if applicable)

Membership & NDIS Information

Are you a Canefield's Community Member?

Yes

Are you a NDIS participant?

yes

If yes please provide your NDIS Number

Access Needs & Considerations

Do you require support to participate in the program?

Yes

Do you require support with communication, literacy, or understanding instructions?

Yes

Unsure

Do you have any medical conditions, allergies, or accessibility needs we should be aware of?

Do you require support with transport to attend?

Yes

Maybe - I'd like to talk to staff about options

Is there anything we should know to support your cultural or spiritual needs during the program?

Referral Source

How did you hear about the Brave Boundaries Program?

Clubhouse staff

Friend or participant

NDIS support

Social media

I give permission for my photo to be taken for program-related purposes.

Yes

I do not consent

I give consent for staff to provide basic first aid if required during sessions. In the case of emergency, staff may contact medical professionals or my emergency contact.

I give consent for staff to provide basic first aid if required during sessions. In the case of emergency, staff may contact medical professionals or my emergency contact.

Yes

I give permission for Canefield's Clubhouse to contact me with updates or future opportunities

I wish to be contacted

I do not wish to be contacted

Disclaimer
Brave Boundaries is a supportive, skills-based workshop designed to help participants build confidence in setting healthy boundaries.

This course is not suitable for professional therapy, mental health treatment or crisis support. If you are currently experiencing a mental health crisis or need one-on-one support, we encourage you to contact a qualified professional or support service.

Participation is voluntary. You are welcome to take breaks, step out, or choose not to share at any time. Your comfort and safety are important.

If you have any access needs, questions, or concerns, please let us know — we’re here to support you.