Step Up Participant Form

Participant Information

Full name(Required)

Phone number(Required)

Do you have dietary requirements?

Do you have accessibility requirements?

Do you have any medical conditions or allergies you'd like to disclose?

Emergency contact details(Required)

Program details

Step Up! sessions are held on 3 separate days in June and July. Details of the sessions are as follows:

22 June (9.30am-4.30pm) | FYA CBD office
6 July (9.30am-5.00pm) | Footscray Community Arts Centre
20 July (9.30am-4.00pm) | FYA CBD office

Are you able to attend all three sessions?(Required)

Yes

If you need to duck our a little earlier or in between any sessions, it should be okay. Please let us know what circumstances prevent you from attending all three sessions.

We're arranging transport funds for each participant attending. What form of transport will you be taking to attend?(Required)

To keep everyone safe, please do a RAT 24 hours before attending the event. We can arrange for RAT tests to be sent to your home. Tests will also be available at the venue.(Required)

I agree

I agree and will need a RAT test mailed to me

What is your address?(Required)

How did you hear about Step Up?(Required)

Social media

Word of mouth i.e. through a friend or someone you know

Through another organisation, council or community group

Other

How did you hear about the program?

Consent and Agreement

Conduct

FYA requires safe and respectful spaces for all. This precludes acts or threats of violence, or conduct reasonably likely to endanger the physical or mental health of yourself or other person, including but not limited to harassment, discrimination and the consumption of drugs or alcohol.

I agree to be respectful of all participants and to respect the health and safety of others.(Required)

Information Collection

My story, image and voice is my own and I give permission to the Foundation for Young Australians (FYA) to collect information about me by:

Interviewing me in person
Surveying me in writing
Taking photos of me

I agree to FYA’s collection of my personal information(Required)

Information Use and Sharing

I decide how other people use and share my story, image and voice

I agree that the information collected from me may be used by FYA:

For activities related to Step Up!

For other activities related to FYA

I agree that the information collected from me may be shared:

With FYA partners

Publicly on FYA’s website, social media, newsletters and marketing materials

Privacy

Information about how FYA collects, uses, stores and discloses personal information, and how you can correct or make a complaint about how we have handled your personal information, can be found in our privacy policy.

I understand that my info will be managed in a way consistent with FYA’s privacy policy(Required)

Child Safety and Wellbeing

Information about how FYA protects children from harm, exploitation and abuse and prioritises the right of every child to feel physically and emotionally safe, including in the way information is managed, can be found in our child safety and wellbeing policy.

I agree that I will act in accordance with FYA’s child safety and wellbeing policy(Required)

Medicine

In the event of any accident or illness sustained I authorise staff from FYA to obtain emergency medical attention and/or an ambulance.

I agree and understand that financial responsibility for medical costs incurred in an emergency rests with myself as a participant of the event(Required)

Full Name(Required)

Date(Required)