Adult Winter Program Registration Form

Select Program *
Use this form to register your place on the waiting list for our adult program. Once you submit your form we will email you a specific winter program information pack. The CareMonkey system will generate medical and permission forms for you to complete online. We do not offer refunds less than 6 weeks prior to the program, so please consider carefully prior to making a booking. If you have any questions regarding the bookings form or procedure you can email our Bookings & Communications Manager at info@mittagundi.org.au. They will usually respond within 2 business days.
Participant Name *
Participant Name
Home Address
Home Address
Date of Birth *
Date of Birth
Transport