Beyond The Square Enrolment Form

Name of Individual *

Date of Birth *

Name of Key Contact *

Email *The invoice will be sent to this email address, so please provide the email that is the best for this purpose.

Residential Address

Street Address *

Address Line 2

City *

State / Province / Region *

ZIP / Postal Code *

Phone 1 *

Phone 2

Support Needs *LowMildModerateHigh

Details of Support Needs *Please list any relevant information such as any injuries, medical conditions and behavioural patterns or special requirements that the workshop tutors may need to be aware of in the planning of workshops. How do you like to be supported when you are having a good day? How do you like to be supported when you are having a bad day? How do you like to communicate? For example, by speaking, using pictures, AUSLAN, a communication device, or another way.

Workshop *Wednesdays at 10am 5 February – 9 April 2025Wednesdays at 12pm 5 February – 9 April 2025Thursdays at 10am 6 February – 10 April 2025Thursdays at 12pm 6 February – 10 April 2025Please indicate which workshop you wish all of the individuals to attend.
Our workshops are currently capped at a maximum of 15 individuals in person. If you wish to submit an application for multiple individuals please do so and we will be in contact regarding available places. Classes require a minimum number of participants to proceed.
If applying for different groups for different session, please complete an application for each session.

Note to Program CoordinatorDo you have questions for the Program Coordinator? Please let us know if you have any particular preferences or considerations. For new participants, we will be in touch to discuss a free, trial workshop before confirming enrolment.

Third Party Permissions

The privacy of our customer data is very important to us. We sometimes need to share your contact information with the third party service provider (the workshop teaching team) to better facilitate communication and notifications. This includes the sharing of emergency contact information, so that we are able to safely support your participation in the workshops. The sharing of information will only be used in reference to the delivery of the workshops.

Do you agree to the Third Party Permissions? *I agreeI do not agree

Media Release Agreement

I agree to City of Parramatta Council, it’s employees, officers, agents and contractors (“Council”) making images or recordings, whether sound, photograph, video, digital or otherwise of attendees to the ‘Beyond the Square’ program (“Beyond the Square Images and Recordings”), and

a) Using, publishing or reproducing the Beyond the Square images and recordings including but not limited to third party social media websites, posters, community newsletters, brochures, television advertisements, promotional videos, websites or multimedia for public relations, reports, documents, promotions (“Promotional Materials”), and
b) Retaining or storing the Beyond the Square images and recordings (including those incorporated into Promotional Materials), in print or digitally.

I agree that in granting these rights to Council I will not receive any payment, royalty or other consideration (whether money or otherwise) from Council or any other third parties in connection with the making, use or storage of the Beyond the Square images and recordings or the Promotional Materials.

I acknowledge and agree that any Promotional Materials which refer to me, expressly or by implication, are, at the date of publication, made in good faith and are not intended to defame or offend me or the subjects or bring me into disrepute.

Do you agree to the Media Release Agreement? *I agreeI do not agree

Name of Organisation *

Name of Key Contact at Organisation *

Email of Key Contact *

Phone Number of Key Contact *

Alternative Phone Number of Key Contact

Postal Address of Organisation

Street Address *

Address Line 2

City *

State / Province / Region *

ZIP / Postal Code *

Street Address *

Address Line 2

City *

State / Province / Region *

ZIP / Postal Code *

Name of Payment Contact *

Email of Payment Contact *Invoices for each individual will be emailed to this contact.

Phone Number of Payment Contact *

Workshop *Wednesdays at 10am 5 February – 9 April 2025Wednesdays at 12pm 5 February – 9 April 2025Thursdays at 10am 6 February – 10 April 2025Thursdays at 12pm 6 February – 10 April 2025Please indicate which workshop you wish all of the individuals to attend.
Our workshops are currently capped at a maximum of 15 individuals in person. If you wish to submit an application for multiple individuals please do so and we will be in contact regarding available places. Classes require a minimum number of participants to proceed.
If applying for different groups for different session please complete an application for each session.

I am enrolling *Select the number of participants you are enrolling. You may enroll up to 10 people. Subject to availability.

Participant / s

Please fill out the details of each participant below.

Name *

Date of Birth

Support NeedsLowMildModerateHigh

Details of Support NeedsPlease list any relevant information such as any injuries, medical conditions and behavioural patterns or special requirements that the workshop tutors may need to be aware of in the planning of workshops. How do you like to be supported when you are having a good day? How do you like to be supported when you are having a bad day? How do you like to communicate? For example, by speaking, using pictures, AUSLAN, a communication device, or another way.

Note to Program CoordinatorDo you have questions for the Program Coordinator? Please let us know if you have any particular preferences or considerations. For new participants, we will be in touch to discuss a free, trial workshop before confirming enrolment.

Third Party Permissions

The privacy of our customer data is very important to us. We sometimes need to share your contact information with the third party service provider (the workshop teaching team) to better facilitate communication and notifications. This includes the sharing of emergency contact information, so that we are able to safely support your participation in the workshops. The sharing of information will only be used in reference to the delivery of the workshops.

Do you agree to the Third Party Permissions? *I agreeI do not agree

Media Release Agreement

I agree to City of Parramatta Council, it’s employees, officers, agents and contractors (“Council”) making images or recordings, whether sound, photograph, video, digital or otherwise of attendees to the ‘Beyond the Square’ program (“Beyond the Square Images and Recordings”), and

a) Using, publishing or reproducing the Beyond the Square images and recordings including but not limited to third party social media websites, posters, community newsletters, brochures, television advertisements, promotional videos, websites or multimedia for public relations, reports, documents, promotions (“Promotional Materials”), and
b) Retaining or storing the Beyond the Square images and recordings (including those incorporated into Promotional Materials), in print or digitally.

I agree that in granting these rights to Council I will not receive any payment, royalty or other consideration (whether money or otherwise) from Council or any other third parties in connection with the making, use or storage of the Beyond the Square images and recordings or the Promotional Materials.

I acknowledge and agree that any Promotional Materials which refer to me, expressly or by implication, are, at the date of publication, made in good faith and are not intended to defame or offend me or the subjects or bring me into disrepute.

Do you agree to the Media Release Agreement? *I agreeI do not agree

Name of Organisation *

Name of Key Contact at Organisation *

Email of Key Contact *

Phone Number of Key Contact *

Alternative Phone Number of Key Contact

Postal Address of Organisation

Street Address *

Address Line 2

City *

State / Province / Region *

ZIP / Postal Code *

Name of Accounts Contact

Email of Accounts Contact *Invoices for each individual will be emailed to this contact.

Phone Number of Accounts Contact *

Workshop *Wednesdays at 10am 5 February – 9 April 2025Wednesdays at 12pm 5 February – 9 April 2025Thursdays at 10am 6 February – 10 April 2025Thursdays at 12pm 6 February – 10 April 2025Please indicate which workshop you wish all of the individuals to attend.
Our workshops are currently capped at a maximum of 15 individuals in person. If you wish to submit an application for multiple individuals please do so and we will be in contact regarding available places. Classes require a minimum number of participants to proceed.
If applying for different groups for different session, please complete an application for each session.

I am enrolling *Please indicate the number of participants you are enrolling. You may enroll up to 10 people. Subject to availability.

Participant / s

Please fill out the details of each participant below.

Name *

Date of Birth

Support NeedsLowMildModerateHigh

Details of Support NeedsPlease list any relevant information such as any injuries, medical conditions and behavioural patterns or special requirements that the workshop tutors may need to be aware of in the planning of workshops. How do you like to be supported when you are having a good day? How do you like to be supported when you are having a bad day? How do you like to communicate? For example, by speaking, using pictures, AUSLAN, a communication device, or another way.

Note to Program CoordinatorDo you have questions for the Program Coordinator? Please let us know if you have any particular preferences or considerations. For new participants, we will be in touch to discuss a free, trial workshop before confirming enrolment.

Third Party Permissions

The privacy of our customer data is very important to us. We sometimes need to share your contact information with the third party service provider (the workshop teaching team) to better facilitate communication and notifications. This includes the sharing of emergency contact information, so that we are able to safely support your participation in the workshops. The sharing of information will only be used in reference to the delivery of the workshops.

Do you agree to the Third Party Permissions? *I agreeI do not agree

Media Release Agreement

I agree to City of Parramatta Council, it’s employees, officers, agents and contractors (“Council”) making images or recordings, whether sound, photograph, video, digital or otherwise of attendees to the ‘Beyond the Square’ program (“Beyond the Square Images and Recordings”), and

a) Using, publishing or reproducing the Beyond the Square images and recordings including but not limited to third party social media websites, posters, community newsletters, brochures, television advertisements, promotional videos, websites or multimedia for public relations, reports, documents, promotions (“Promotional Materials”), and
b) Retaining or storing the Beyond the Square images and recordings (including those incorporated into Promotional Materials), in print or digitally.

I agree that in granting these rights to Council I will not receive any payment, royalty or other consideration (whether money or otherwise) from Council or any other third parties in connection with the making, use or storage of the Beyond the Square images and recordings or the Promotional Materials.

I acknowledge and agree that any Promotional Materials which refer to me, expressly or by implication, are, at the date of publication, made in good faith and are not intended to defame or offend me or the subjects or bring me into disrepute.

Do you agree to the Media Release Agreement? *I agreeI do not agree

Beyond The Square Enrolment Form

Dates & Times

Cost & Additional Details

Locations

Instructions

Beyond The Square Enrolment Form

Dates & Times

Cost & Additional Details

Locations

Instructions

Term 2 Workshops 2025