School Education Booking Form
Which school are you from?
*
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Your contact details
Main contact name
*
First Name
Last Name
Main contact email
*
example@example.com
Main contact phone
*
Please enter a valid phone number.
Format: 0000000000.
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Alternate contact
Please provide and alternate contact incase we can't reach you.
Alternate contact name
First Name
Last Name
Alternate contact email
example@example.com
Alternate contact phone
Please enter a valid phone number.
Format: 0000000000.
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Booking details
Tell us how we can help strengthen your school culture!
Presentation/Program type (select multiple if applicable)
Impact: Bullying Prevention, Year 5/6s (90 minute classroom based workshop) - Violence Prevention Program
Impact: Cyber Bullying, Year 7/8s (90 minute classroom based workshop) - Violence Prevention Program
Impact: Respectful Relationships, Year 9/10s (90 minute classroom based workshop) - Violence Prevention Program
Party Wise (90 minute classroom based workshop) - Alcohol and Other Drugs Education
What's the Story (8 week program) - Manhood & Masculinity
Adulting 101 (8 week program) - Transition to Adulthood
True Colours (8 week program) - Inquiry-based bullying prevention program
Impact Presentation only (45 minute, large cohort, suitable for year 5+)
What workshop spaces do you have available?
*
Individual rooms are recommended for workshops, however we can be flexible with room arrangements
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Program Details
Preferred date(s) of session(s)
Please provide multiple dates if your sessions are to be held over multiple days
Preferred start time of session(s)
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Details of your eight week program
Start date of your eight week program
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
End date of your eight week program
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Day of your weekly sessions:
Start time of your weekly sessions:
Hour Minutes
AM
PM
AM/PM Option
End time of your weekly sessions:
Hour Minutes
AM
PM
AM/PM Option
Student details
Number of participants
*
Year level(s)
*
Aim of session
Are there any specific concerns you would like to cover?
Do your students have any specific needs that we should be aware of?
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Where will we meet you?
Address
Street Address
Street Address Line 2
City
State
Post Code
Where to meet
Front office, auditorium etc
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Presentation Equipment/Software
Equipment available
*
Projector
Projector screen
Audio/speakers
PA System
Smartboard
Other
Please specify
Presentation software
*
VIVI
Other
Please specify:
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How did you hear about us?
Online
Word of mouth
Email
Previous program
TV
Other
Please specify:
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Our team would love to be able to get a photo to share your involvement in our education program. Do you have two (or more) student representatives with photo consent who could participate at the end of the session? If so, please tell us who!
Do you have any other relevant information we should be aware of?
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Invoice Details
Accounts contact name
*
Accounts contact email
*
Accounts contact phone
Accounts address
ABN
Purchase order number
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Submit
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