Therapeutic Parenting Registration Form

Therapeutic Parenting provides support, connection and practical help for parents with adopted children in their family. Please select the relevant group from the drop down menu below.

Before you submit the form corresponding to the group you wish to attend please review our Group Agreement and Privacy Collection Notice.

Therapeutic Parenting Registration Form

If you are unsure or do not understand any part of this form or would like to register over the phone, please contact your relevant service: PARC (NSW) on 02 9504 6788 or PASQ (QLD) on 07 3170 4600.

New Panel 1

Select Group Name & Date

Please select one Therapeutic Parenting Course - Commencing 22nd of February 2023

Full Name* - required

Your Date of Birth* - required

Your Gender

-Select - Male Female Self Described/ Other

Phone Number* - required

Your Email* - required

Your Street Address* - required

Your Suburb* - required

Your Post Code* - required

Your State* - required

Please Select One NSW QLD Other

Your Cultural Background* - required

I am* - required

 Adopted  Birth Parent  Adoptive parent  Other, please specify bellow

Other

Which language do you speak most at home?* - required

How did you hear about us?* - required

 PASQ/PARC Facebook  Word of mouth  PASQ/PARC Counsellor  Government Department  Other

If other, please specify

Would you like an Interpreter or support service whilst accessing this group?* - required

Select One Yes No I'm not sure, please contact me.

Name of others attending with you & Relationship* - required

Adopted Childs Details 1

Child 1

Child Name

Type of Adoption

Select One Local International Intrafamily

Country of birth

Childs Age* - required

Adopted Childs Details 2

Child 2

Child Name

Type of Adoption

Select One Local International Intrafamily

Country of birth

Childs Age

Adopted Childs Details 3

Child 3

Child Name

Type of Adoption

Select One Local International Intrafamily

Country of birth

Childs Age

Privacy and Consent

Should you require further advice or clarification before providing your consent, please contact your relevant service: PARC (NSW) on 02 9504 6788 or [email protected], or PASQ (QLD) on 07 3170 4600 or at [email protected]. 

I wish to receive Post Adoption News quarterly to my email

By submitting this form, I consent to participate/receive support from the above mentioned group. I understand I can leave the group at any time. I consent to my personal information, the full name of any other attendees listed in this form and the personal information in this form being collected, used, disclosed and stored as set out in the Privacy Collection Notice (above). I confirm I am the legal guardian of the child/ren listed in this registration form. I understand I need to inform The Benevolent Society if I no longer wish to consent to the terms in this form.* - required

I agree to participate according to the responsibilities listed in Groups Agreement (above) these being confidentiality and respect of others, support of speakers and understanding I can direct any questions to counsellors.* - required

I would be open to participating in external evaluation as part of service improvement activities

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