Expression of Interest
This form is to express your interest in attending Left Write Hook Program in mid October - early December 2023. 
The Bentleigh program runs for 8 weeks, starting Saturday October 14 - Saturday 2 December. 2pm to 430pm.  Please note there are limited spaces available and so we appreciate you ensuring you have registered and paid two weeks before the program start date.

The Bentleigh program will be run by Maryanne Dib and co-facilitated by Belinda Jane. Each program will have a facilitators assistant (all our facilitators are lived experience) who will assist with the overall facilitation and boxing. 

To get started, follow the instructions below. 

  1. Read through this form and answer the questions. These questions are for the program facilitators to ensure they can design the best program possible and take into account everyone's needs and requirements. If you don't feel comfortable answering any questions, then please leave them blank. If there is anything missing from this form or if you have feedback about this form, please feel free to contact Founder Donna Lyon on donna@leftwritehook.com
  2. All information collected is private and will not be shared with anyone. 
  3. We like to talk to all participants before they start the program to make sure that it is the right thing for you and your recovery at this point in your life. Maryanne will reach out to you prior to the program commencing to arrange a time to connect.
  4. Left Write Hook is an adjunct to therapy or mental health programs. It is not designed as a substitute for therapy. The program will no doubt bring things up, so you need to make sure you have the right support and resourcing in place. We will have resources available via our workshop manual, but no therapists on hand. Talking about abuse is triggering, so just showing up can be triggering. We are there to aid your recovery through a trauma-responsive and empowerment framework, but we also need you to commit to working on your recovery before, during, and after attending in order to maximise your results. 

All participants will be asked to sign a waiver form, fill out emergency contact form and be provided with a manual with program outline and resources. A health screening and assessment form is required before participating in group exercise. These forms will be sent online to you after registration. You will need to fill these out and return. 
Email *
The LWH program in Bentleigh commences Saturday 14th October - 2nd December
Program Price: 
$400 per person, for the 8 week program. Payment is due in full one week before the program starts.
Please note we have a Pay-What-You-Want model. Please include this in section below.
Name *
Email *
Mobile *
Information Section
This workshop is designed for female identifying and gender diverse victim/survivors of abuse and trauma. 

We do not discriminate against participants based on race, age, colour, ability, religion or sexuality. At the moment, Left Write Hook is not set up for workshops for cis-male survivors. There is a desire to develop a program focused on men in the future so if you are interested in this, you can submit a form and we will keep you on the mailing list.

To help us ensure we provide the best diversity and intersectionality  framework possible, we appreciate you providing any of the following information that you feel comfortable to share. Some information is required, others are optional.
Age or Age Range *
Gender *
Are you First Nations?
If you like, please share your cultural heritage
If you like, please share your religion or faith
If you like, please share your sexuality
If you have access requirements, please share
Fitness Range *
Do you have any injuries or physical impairments that are important for us to know before you attend the class to ensure that we provide you with the most supported training and activities? *
Have you ever done boxing before? 
 *
How do you feel about hitting pads? *
Have you ever done group work with survivors before? *
What interests you most about Left Write Hook? *
Required
What do you want to get out of the Left Write Hook program? *
Are you currently receiving support for your sexual abuse/ trauma history? *
How did you find our about us? *
Empowering Accessibility: Pay What You Want. Our program welcomes survivors facing financial barriers. Set your price, aligning with your means and program value. If you can, the sustainable cost to the program cost is $400. Your support matters.
Please leave any additional information that you would like us to know in the space below or write any questions you may have.
What happens next?
The facilitator (Maryanne Dib) will make contact via email or text to arrange a time for a short introduction phone or zoom chat to ensure the program is the right fit. 
You can contact Maryanne on 0422 331 419.

After this and you are ready to join, then you will be sent a program information sheet with payment details and relevant waivers and health screening information. Upon receipt of your payment, your spot will be secured.


We look forward to you coming on this journey with us.

If anything has come up for you whilst filling out this form and you need support, please contact the free service: 
Sexual Assault Crisis Line: 1800 806 292

For confidential information, counselling and support service, please call: 1800RESPECT for free, 24 hours a day, 7 days a week. This service  supports people impacted by domestic, family or sexual violence.

If you are feeling suicidal, please call Lifeline on 13 11 14 for 24 hour support.

Please go gently.
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