Welcome

Welcome to the RACR Registration Form.

You can complete this form yourself OR if you need assistance, please call us on 1800 960 540 to complete it over the phone.

We are not a crisis service. If you are in crisis, please call Lifeline on 13 11 14. If you are in immediate danger, please call 000.

Fees: Please note that this is a fee for service program. Fees are charged based on a sliding scale according to your income, for calculation of fees please visit https://racr.org.au/services/counselling/.

Counselling services are not eligible for Medicare or Private Health Fund rebates and are not covered under a Medicare Mental Health Treatment Plan. Fee exceptions may apply depending on your personal circumstances, which we may call you to discuss further.

If you’re accessing counselling services through your employment’s Employee Assistance Program (EAP), please complete the RACR EAP Enquiry Form instead.

Please note that our Coronial Counselling program is available for matters under investigation in the ACT Coroners Court.

Support is available throughout the coronial investigation process and up to three months after the investigation has concluded.

What is your preferred location to access our Children's Contact Services? *

Wagga Wagga

What is your preferred location to access our Gambling Support Services? *

Canberra

What is your preferred location to access our Group Programs? *

CanberraWagga Wagga & Riverina

Group Programs (Canberra) *

Building Better RelationshipsTuning into Kids (for Dads)Women: Reclaim

Group Programs (Wagga): *

Women: Reclaim

As per our contract to deliver mediation services, RACR is only able to provide services to those within our service locality. This means you and / or the other party must be residing in one of our eligible service postcodes. Please confirm that at least one party lives in an eligible location using the checker below.

Postcode Eligibility Checker

I confirm at least one party resides in an eligible location *

YesNo

For alternative Relationships Australia locations please visit: relationships.org.au

What is your preferred location to access our Men's Behaviour Change Program? *

Wagga Wagga & Riverina

What is your preferred location to access our Senior Relationship Services? *

Wagga Wagga & Riverina

Have you received a letter from Relationships Australia Canberra & Region inviting you to Family Dispute Resolution (Mediation)? OR are you initiating the process? *

I am initiating this process.I received a letter of invitation.

What Service are you requesting? *

Parenting / GrandparentingProperty MatterBoth

*If you require both, generally the service will start with parenting.

What is your preferred location to access our Coronial Counselling services? *

CanberraVirtual / Telehealth

I am seeking Coronial Counselling: *

For myselfWith my partner/sWith my familyFor my child under 16

Note: This form will need to be completed by each individual participating in counselling that is over the age of 16.

Services are offered weekdays from 9am – 5pm

I am seeking counselling: *

For myselfWith my partner/sWith my familyFor my child under 16

Note: This form will need to be completed by each individual participating in counselling that is over the age of 16.

We understand that people often seek support for multiple reasons. To help us find the best counsellor for you, what is the primary reason you are seeking counselling: *

I want to improve my wellbeing or relationships, or work through a challenge in individual counselling.I am considering separating, in the process of separating, or have separated from a significant other.I am experiencing or have experienced family, domestic or sexual violence.I experienced child sexual abuse while in the care of an institution and am considering a Redress applicationI am experiencing or impacted by gambling harm.I am concerned I have used domestic, family or sexual violence and want to make a positive change.I want to improve my parenting skills and confidence.

We understand that people often seek support for multiple reasons. To help us find the best counsellor for you, what is the primary reason you are seeking counselling: *

We want to improve our relationship and would like counselling as a couple.We are considering separating, in the process of separating, or have separated.We are experiencing or have experienced family, domestic or sexual violence.We are experiencing or impacted by gambling harm.We want to improve our parenting skills and confidence.

We understand that people often seek support for multiple reasons. To help us find the best counsellor for you, what is the primary reason you are seeking counselling: *

We want to improve our relationships and would like counselling as a family.We are considering separating, in the process of separating, or have separated.We are experiencing or have experienced family, domestic or sexual violence.We are impacted by gambling harm.

We understand that people often seek support for multiple reasons. To help us find the best counsellor for your child, what is the primary reason they are seeking support: *

To improve relationships and social skills.To help manage a family breakdown or separation.They are experiencing or have experienced family, domestic or sexual violence.To improve their mental health or emotional wellbeing.To gain coping skills for grief/loss, a life change or challenge.

Something else

Additional areas that they would like to work through are: (select up to three)

Relationship concernsFamily and domestic or sexual violence Mental health or emotional wellbeingGrief or lossFriendships, bullying or social concernsSchool challengesExploring identity, sexuality or gender expressionLife changes or stressSafety concerns or thoughts of harm to self or others

Other

Please be aware RACR is not a crisis service.

If there is an immediate danger call emergency services on 000.

If you are in crisis call Lifeline on 13 11 14.

Consent & Confidentiality

Personal information

Relationships Australia Canberra & Region (RACR) uses your personal information primarily for contacting you for appointments. Your personal information is protected by law, including the Privacy Act 1988 and the Family Law Act 1975. Personal information is maintained, securely stored and disposed of under conditions that ensure confidentiality, and respect your privacy and dignity.

Data Reporting

RACR receives funding from a variety of sources, including Commonwealth, State and Territory Governments, private and public organisations, trusts, and charities.

RACR collects information to assist our funders to review and evaluate the services that you receive from this organisation. We only provide information in a de-identified format so no individual can be identified through this process.

Future research by funding bodies

As part of our funding agreements, RACR clients are provided with an opportunity to participate in future research projects conducted by our funding agencies and third parties (such as universities). Potential future research projects are to better understand client needs and provide opportunities to improve service delivery.

Participation is voluntary and you are under no obligation to provide consent to take part in these projects.

Further information

For further information on the use and reporting of information, please see https://racr.org.au/about-us/privacy-and-confidentiality. Please let the staff know if you have any concerns or questions.

Acknowledgement

I have read and understood the information above and agree to receive the service on the terms outlined above. *

I understand that information will be disclosed to funders (in a way that will not identify me) for the purpose outlined in this form. *

I consent to participate in future research projects conducted by funding agencies and/or third parties.

Agreement to Participate

Please note this document has been written for parenting and property matters. Not all information will apply to you where you are only attending one process.

Confidentiality and Admissibility

Communications made to an FDR practitioner are confidential and unusable in court. Limits include:

Serious concerns about the safety of a party or child (mandatory reporting)
The provision of information to Independent Children’s Lawyers
Consultation between practitioners

Role of a Family Dispute Resolution Practitioner (FDRP)

All FDRPs are accredited under Family Law Regulations. Their role is to:

Assess cases to determine mediation is suitable on an ongoing basis, considering if any of the following affect the ability for parties to negotiate freely:

the presence of (including a history of) family violence among the parties, or the parties and their children;
the likely safety of the parties, or of any other person involved in the conduct of sessions;
the equality of bargaining power amongst the parties;
if the dispute involves children—the risk that a child may suffer abuse;
the emotional, psychological and physical health of the parties;
the undue bias or influence of a person (whether or not the person is a party to the dispute) on the parties;
any other matter that the practitioner considers has a material impact on the ability of the parties to negotiate freely.

Note: FDRPs may discontinue mediation at any time if they assess the case as no longer suitable, without disclosing the reason.

Remain impartial while facilitating safe, structured discussions to help parties reach mutually acceptable agreements.
To encourage parties to seek legal advice (while not providing any)
To record Parenting Plans and/or Property Agreements
To establish best interests of the child as paramount (parenting matters)
To conduct process in line with the Family Law Act 1975 principles.

Fees

Fees for Family Dispute Resolution services are charged based on your income.

Use the fee calculator on our website to find your rate:

Family matters: racr.org.au/services/family-mediation/

Property matters: racr.org.au/services/property-and-financial-mediation/

Feedback

If you wish to register feedback you can:

Raise this with the FDRP
Visit https://racr.org.au/contact-us/feedback

For Parenting Matters only

Child Informed Practice (CIP)

Depending on service availability, appropriateness, and the consent of both parties, children may be able to see a child consultant who then provides feedback to parents.

Fees are payable for CIP sessions and can be calculated at: racr.org.au/services/family-mediation/

Section 60I Certificates

Generally, a party must attempt FDR before court for parenting matters. A S60I certificate may be requested if FDR is unsuccessful stating:

a. The other party did not attend;

b. FDR was assessed as not appropriate;

c. A genuine effort was made at mediation to resolve issues;

d.There was not a genuine effort made in FDR to resolve issues; or

e. The FDRP decided it was not appropriate to continue partway.

Courts may award costs if there is no attendance or effort from a party.

Acceptance of Obligations for Participants

Applies to ALL matters:

1. I will voluntarily and respectfully participate with everyone involved in the FDR process.

2. I will promptly reply to the centre and update my contact details if needed.

3. I understand that children cannot attend appointments (except CIP).

4. I understand FDR takes up to 3 hours and will ensure my full attendance.

5. If appointments are held via phone or video, I will attend in a private place without distraction.

6. I understand that no one can attend appointments that has not been agreed to by both parties and the FDRP.

7. I will keep this process confidential and will not publish any related information.

8. I will pay any fees due and have calculated my fees online.

9. I understand that I need to provide at least 48 hours’ notice to change or cancel my appointment, and cancellation fees will apply if this does not occur.

10. I understand services may discontinue if the above is not followed.

11. I understand that my following my mediation session, my file will be closed within 2 weeks unless both parties have indicated wanting to attend further sessions, and the service finds it appropriate.

Applies to parenting matters ONLY:

1. I understand the priority in this process is to work towards the best interests of the child/children (Family Law Act 1975,Section 60CC), and this includes the following general considerations:

a. The safety of the child and people who care for the child (including any history of family violence and family violence orders);

b. The child’s views;

c. The developmental, psychological, emotional and cultural needs of the child;

d. The capacity of each person who will be responsible for the child to provide for the child’s developmental, psychological, emotional and cultural needs;

e. The benefit to the child of having a relationship with their parents, and other people who are significant to them (e.g. grandparents and siblings); and

f. Anything else that is relevant to the particular circumstances of the child.

Applies to property matters ONLY:

1. I understand that I have a legal duty to disclose all financial/personal information and papers relevant to the matters to be discussed in property mediation to the other party. I understand if I fail to do this, and court is initiated, consequences can include:

a. Punishment for contempt of court with a fine or imprisonment;

b. Cost orders against a party; or

c. The court taking non-compliance into account when determining orders.

2. I understand that any and all information I provide about assets, liabilities, superannuation or other items may be used to prepare a joint balance sheet that is shared between the parties at mediation.

3. I will prepare for the mediation and bring all financial details and documents that are required to facilitate the process.

By signing this, you are only agreeing to the content that relates to the service you are using.

Child / Young Person Signature *