About You

Please complete this 5 minute survey to register your interest in attending CaPSS' programs. *Please note that in-person programs are held within the Cities of Melton and Wyndham.

The Salvation Army is committed to caring for people by protecting personal information and upholding the Australian Privacy Principles. To read our privacy policy please visit salvationarmy.org.au/privacy. By providing us with your personal information or by using the website, you are confirming your agreement to the content of our privacy policy.
Note: if you would like to register interest on someone else's behalf, please email capss@salvationarmy.org.au to ask for a referral form.

Question Title

* 1. What is your First Name?

Question Title

* 2. What is your Last Name?

Question Title

* 3. Gender

Question Title

* 4. Please state your suburb, state and postcode.
(CaPSS programs are limited to Western areas of Melbourne)

Question Title

* 5. Email address and phone number (for links and reminders)

Question Title

* 6. How do you prefer to be contacted?

Question Title

* 7. When is the best time and day to contact you (between the hours of 9 am - 5 pm Monday to Friday)?

Question Title

* 8. What is your date of birth?

Date

Question Title

* 9. Do you identify as either Aboriginal or Torres Strait Islander

T