Service User Registration Form

Roundabout Canberra is a volunteer-powered local charity. Our aim is to provide women and families experiencing hardship in Canberra, and the surrounding NSW regions, with essential items and equipment to ensure the safety of their babies and children. We work directly with social workers and social service agencies to help individuals and families in need. To access our service you must work for a social service or community welfare agency. Please fill in the form below to register as part of our network.

If you or someone you know is in need of items, and you are not already connected with a social worker, please see our Get Help page for more information.

First Name*

Last Name*

Email*

example@example.com

Mobile*

Example: 04xxxxxxxx

Work Number

(example: 04xxxxxxxx or 02xxxxxxxx)

Your organisation*

Your role/position*

Is your role Government sponsored?*

Are you receiving funds from the ACT/NSW or Commonwealth Government to perform your current role?

How did you hear about us?*

Please tell us more about how you heard about us

I have read and understood the Roundabout Canberra Registration & Collection Policy.