Community Group Request Form

If you represent a refugee or asylum seeker support organisation, and feel that your members would benefit from an interactive health session delivered by The Water Well Project- please complete this short form.


    Group Details

    Are you from an organisation based in Australia?*


    Name of Community Group*


    Preference for Facilitator Gender*

    Number of People In Community Group (eg. 20)*

    What is the Gender Split of the Group?*

    What is the Venue Address where the Session would take place?*

    Do you have any preferred Meeting Dates and Times?*

    Is an Interpreter Required?*

    Are there any specific Topics of Interest (eg. Diabetes)?*

    Your Details

    Your Name*

    Your Organisation*

    Your Email*

    Your Phone Number*

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    Dandy Pals Playgroup Pic