Box Hill Community Arts Centre - Online Registration Enquiry

Thank you for your enquiry regarding attending one of our activities/courses at the Box Hill Community Centre. Please complete the details below and I will be in touch with you shortly to confim the details and your registration.

Kind regards
Lizzy Sampson, Programs and Youth Arts Project Officer

Fields marked with * are mandatory

Contact Details

Contact Person:*

Address:

Suburb:

Postcode:

Email Address:

Contact Number:*

Preferred Contact Method:

Email
Phone

Have you attended a course/activity at the Box Hill Community Art Centre previously?:

Where did you hear about Box Hill Community Art Centre?:

Attendee Information

Name of Attendee 1:*

Date of Birth (if under 18):

Name of Attendee 2:

Date of Birth (if under 18):

Name of Attendee 3:

Date of Birth (if under 18):

Name of Attendee 4:

Date of Birth (if under 18):

Course / Activity Details

Name of Course / Activity:*

Date of Course / Activity:*

Time of Course / Activity:*

Privacy

The personal information requested on this form is being collected to enable the Box Hill Community Arts Centre to contact you regarding this enquiry. The personal information will be used by the Box Hill Community Arts Centre for that primary purpose or directly related purposes only. The information will not be released unless required by law. The applicant may apply to Council for access and/or amendments of the information.