A heart for healthy food

VOLUNTEER FACILITATED PROGRAM

Do you have your:
1. Letter of Approval for CHIP Program  2. List of the scheduled program dates
Ready to email to support this registration?
CHIP Program Registration
Church or Community Group *
Type of Program *
Resources Required *
Is your program limited to a certain demographic? *

Please provide details. Eg: retirees, young mums, unemployed, people with high blood sugar etc.

Certified CHIP Facilitators Assisting in the Program

Attach a separate document if needed

Please attach approval letter

Please indicate your anticipated charges for the program

(Includes Attendance, CHIP Kit/CHIP Hub, Bloods, Program Expenses)

(Includes Attendance, Bloods, Program Expenses)

(Includes Attendance, Program Expenses)

(Attendance (FREE), Includes Bloods, Program Expenses)

Attendance (FREE) No inclusions

Acceptance *
Please email the following to support this registration
1. Letter of Approval for CHIP Program  2. List of the scheduled program dates

The Letter of Approval for CHIP Program should be completed by the local Church or Community Board (the Insurance provider for the program).

List of scheduled program dates. Forms available for download in MSWord or PDF format.
MSWord doc  |  PDF doc

Return Completed Form LMI CHIP 6 weeks prior to the program commencing

ask@chiphealth.com.au
Phone +61 (02) 9847 3367