Carer Wellness Programs For previously registered Carers – Click here if you have not previously registered with us Name Email Home Phone Number Mobile Phone Number Date of Birth (dd/mm/yyyy) Address Who do you care for? Please provide detail about your role What is their Medical condition/Diagnosis? Which Retreat are you registering for? Date of Retreat Are you registered with Wellways? Yes No How did you find out about the Carers Retreat program? Have you previously attended one of our Retreats What was the date of the retreat you attended On a scale of 1 to 5 (1 is low level and 5 is very high) How would you rate (please tick) your current level of stress? 1 (low) 2 3 4 5 (high) I consent to participate in the Carers Foundation wellness program and the activities listed in the program. I have read information on how the Carers Foundation cares for my privacy (please see below) Please type 'I Agree' Thank you we will be in touch with you as soon as possible to discuss
