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Disability Engagement Register: Leave

This form will allow your name to be removed from the Disability Engagement Register. 

Your Privacy

All information collected as part of the Disability Engagement Register - Leave form process will be kept strictly confidential and stored in a secure file.  Personal information will not be distributed to third parties, except where required by law.


The DCSI Privacy Statement sets out the Department for Communities and Social Inclusion's (DCSI) policies relating to the privacy and security of your personal information, and the Government of South Australia's Information Privacy Principles (IPPs) (PDF 296kb) issued by the Department of the Premier and Cabinet. 


If you require assistance with this form, please contact Disability SA on 1300 786 117 between 9.00am and 5.00pm Monday to Friday or send an email to    An alternative format is available, click here to download a printable version of the form.