Aspire2Health Charleville | Registration

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Aspire2Health Charleville | Registration

Welcome to the Aspire2Health Charleville registration page. Aspire2Health is a collaboration between Griffith University, Southern Queensland Rural Health, the University of Queensland - Rural Clinical School, the University of Southern Queensland, Queensland Ambulance Service, Darling Downs and West Moreton Primary Health Network, Western Queensland Primary Health Network and Toowoomba and Surat Basin Enterprise. To ensure we have all your details, please ensure you complete every question.

15Questions

Language

English (UK)

1
Please select the Aspire2Health event you are registering for.* This field is required.
Tuesday, 02 August 2022
2
Student Name* This field is required.
First Name
Last Name
3
School* This field is required.Please select the student's school
Charleville State High School
4
Student Grade* This field is required.Please select the student's year of study
Year 9
Year 10
Year 11 or 12
5
Student contact information* This field is required.Please enter a contact email address for the student for registration confirmation
example@example.com
Confirm Email
6
Student contact information* This field is required.Please enter a contact mobile number for the student to receive reminders and notifications
7
Does the student identify as a Aboriginal or Torres Strait Islander?
YESNO
8
Student Dietary Requirements* This field is required.Please select the student's dietary requirement.
No dietary restrictions
Gluten Free
Vegan
Vegetarian
9
Parent/ Guardian/ Carer Contact Information* This field is required.Please enter the parent/ guardian/ carer's name
First Name
Last Name
10
Parent/ Guardian/ Carer Contact Information* This field is required.Please enter the parent/ guardian/ carer's mobile contact
11
Parent/ Guardian/ Carer Contact Information* This field is required.Please enter a contact email address for the parent for emergency contact
example@example.com
Confirm Email
12
What health professional career is the student interested in?
Doctor
Paramedic
Nurse
Midwife
Occupational Therapist
Speech Pathologist
Dietitian
Pharmacist
Medical Laboratory Scientist
Radiographer or Sonographer
Social worker
Psychologist or Mental Health Worker
Aboriginal Health Practitioner
Podiatrist
Dentist or Oral Health
13
Why does the student want to attend the Aspire2Health Workshop?Please note that if the workshop is full this question will guide the selection process.
14
I consent to my child attending the Aspire2Health event.* This field is required.
YESNO
15
I consent to photos and videos of my child being taken during the Aspire2Health event for advertising and marketing purposes, for Aspire2Health organisations to report to their funding organisations, and for sharing with my child's school for their local newsletter.* This field is required.NOTE: Selecting ‘NO’ will not prevent your child from participating in the event.
YESNO
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