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.

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

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

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

To proceed, you must provide either the other party's email or residential address.

Please note that the information requested below is used solely to verify the Other Party's identity and link them to your profile. The Other Party will not be contacted until your intake is complete and you have confirmed that you are ready for a Letter of Invitation to be issued.

Please note that the information requested below is used solely to verify the Other Party's identity and link them to your profile.

To proceed we require the other party’s contact details, including at least one of the following: phone number, email address, or residential address, to enable the service to extend an invitation to participate.

After submitting this form, a member of our team will be in contact with you.

Please note that calls may come from a private number.