Register Interest for Birth Forum

register your interest

Please register your interest and let us know if you would like to actively contribute to making meaningful change for the Kununurra maternity system.

First Name

Last Name

Company or associated business

Photos may be taken during the forum for the purposes of documenting the event. Please indicate your preference below. Required

I consent to photographs of me being taken and used for social media and other promotional purposes.

I do not consent to photographs of me being taken or used.

I understand that photographs of children attending the forum will not be intentionally published on social media by the forum organisers. I understand that I should not photograph or record other participants or their children without their permission. Required

I understand and agree to this requirement.

The forum will be recorded and may be used to provide feedback to the hospital and for social media. If you do not consent to being recorded, please avoid identifying yourself or speaking during the recorded session. Required

I understand and consent to the recording and use of my image, voice and comments for these purposes.

I do not consent to being recorded.

We ask that everyone participates respectfully and is mindful of the different experiences and perspectives shared during the forum. Please respect the privacy of other participants and allow everyone an opportunity to contribute. Required

I agree.

Participant declaration. Required

I confirm that I have read and agree to the above.

Thanks for submitting!

the nurtured mother

register your interest

ⓒ 2026 The nurtured mother