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ASNA Centre for Disability Studies: Programme Registration Form
Please use this form to register for the ASNA event you would like to attend. We will send further details once we receive this form.
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Email
*
Your email
Please tell us which event/s you are registering for below.
*
'Making The Gospel Accessible' - Online Disability Awareness
Here 2 Hear Carers Support Group (Last Friday of the Month carers drop - in meetings 2022)
Carers Creative (Quarterly meeting 2022)
Connecting Carers (& Supporters) Network support day 21st October 2023
ASNA Music and Art Academy 121 lessons
Other:
Required
Title
*
Mr
Mrs
Ms.
Dr. (MD)
Pastor
Dr. (PhD / DMin)
Miss
Master
Professor
Other:
Required
First name
*
Your answer
Surname name
*
Your answer
Postal Address
*
Your answer
Telephone number
*
Your answer
Occupation
*
Full time student
Professional working 9-5
Entrepreneur
Retired
Health Care worker
Educator
Other:
Required
Church (if applicable)
*
Your answer
Do you hold a position in your church community?
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Yes
No
Other:
Please tell us about you and if you have any caring responsibilities.
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I have a son / daughter with special needs
I look after someone with a disability
My son / daughter lives at home with me
My son / daughter lives in supported living / independent living
I do not have a family member with a disabilities
I am a paid carer interested in disability ministry
Other:
Required
Please let us know if you have had disability awareness training before and where
*
Yes I have had lots of training and I am very knowledgable in this area
No i have never had any training in this area at all
Yes I have received training through ASNA before
I have some knowledge in this area
Other:
Required
On a scale of 1 - 10, tell us how confident you are with your understanding of disability awareness and inclusion.
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Very aware
1
2
3
4
5
Very little awareness
Thank you for sharing your details with ASNA. We do not take this lightly. Please indicate below whether you consent to ASNA using your details for ASNA purposes only. Your details will be stored with password protected security. Please let us know if you would like your details to be removed at any time.
*
Yes I consent to my information being available for ASNA to use as indicated above
No I do not consent to my details being stored
Other:
Please indicate below your consent to your image being stored or used for ASNA purposes (such as report writing, funding applications, promotion and marketing on ASNA social media platforms and website).
Yes I give my consent for my image to be used as above
No I do not give my consent to my image being used for any purposes
I consent to a still image being used for hard copy material
I consent to video images being used as above
I consent to my photo images being used for ASNA hard copy material only
Other:
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Would you like ASNA to send you further updates, or details of other ASNA or related events?
*
Yes
No
Maybe later
Other:
Send me a copy of my responses.
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