Client Registration Form
If applicable, preferred first name
Full date of birth*
I consent to Relationships Australia WA contacting me at a later date to ask me how I experienced the service.
Your household composition
Single (person living alone)
Sole parent with dependant(s)
Couple with dependant(s)
Group (related adults)
Group (unrelated adults)
Are you Aboriginal or Torres Strait Islander?*
Torres Strait Islander
The main language you speak at home*
Your country of birth*
If you were not born in Australia, what date did you first arrive in Australia
If you were not born in Australia, what is your migration visa category
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.*