Client Registration Form
Full date of birth*
Client Contact Information
The main language you speak at home*
Are you Aboriginal or Torres Strait Islander?*
Torres Strait Islander
Your country of birth*
Below is important information about your right to privacy. Please read this section prior to accessing our services.
Privacy and your information
Relationships Australia is committed to your right to confidentiality and privacy. This information details the conditions of receiving a service from Relationships Australia WA.
As a parent/guardian, I agree on behalf of a young person under 18 years
By typing my name I acknowledge I have read and understood Relationships Australia’s conditions of receiving a service and agree to these terms around privacy.*