Family Registration

Step 1 of 2

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Name Old

First Last

Name(Required)

First Last

Partner's Name(Required)

First Last

Email(Required)

Phone - Landline

Phone - Mobile

Are you happy for us to communicate with you via Facebook Messenger?(Required)

Yes

Your Facebook Page url

Username - Create One(Required)

Password - Create One(Required)

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Username - RT Create One(Required)

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Password - Create One(Required)

Property Physical Address(Required)

Street Address Suburb City State Postcode

Please enter the children's ages, names and school year level separated by commas in each field. 6, Sarah, Grade 1

Ages(Required)

Childrens names(Required)

Grades

Information about your family - a little background please.(Required)

How did you hear about Bushed?(Required)

Support Services(Required)

We are interested in the Mothers In Arms program.

We are interested in having access to a tutor.

We are interested in MIA and accessing a tutor

We are interested in receiving financial assistance only

We are interested in music support

We need post disaster support.

We are interested in all forms of support

We will ask for some additional information on the following page, please continue.

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