Complete the following questions to express your interest in participating in a scheduled My Recovery program. We will contact you to confirm receipt and your enrolment in the program you have nominated. Please note: If you are completing this form for someone else, it is expected that person has provided you with consent.Name:*Address:*Phone:*Email* Why do you want to do the My Recovery program?*select all that apply To meet new people Explore and try new things Better connect with family and friends Understand more about mental health To learn new skills Learn what works for me Be in a safe place to step out of my comfort zone OtherWhat recovery skills or strengths would you like to develop?*select all that apply Communication How to speak up for myself Discovering my story OtherDo you have someone who will support you through this program?* Yes NoIf yes, why did you choose them?I acknowledge that I am:*select all that apply Over 18 Living with mental health challenges or other related issues (trauma, alcohol and/or other drug issues) On my own journey of recovery Prepared to access support during the My Recovery program Prepared and willing to commit to attending all 9 sessions of the programDetails of My Recovery program you want to attend:*Please write down the name of the My Recovery program and start date for the program that you want to attend:Challenges or barriers to participationIf there are potential barriers to your participation that you would like us to talk to you about, please let us know (e.g. transport, kids, work or other commitments). There may be practical ways we can help.CAPTCHAΔ