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?*
 Yes No

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*



Dandy Pals Playgroup Pic