IPPS and Coaching Programs: Application & Consent

IPPS and Coaching Programs: Application & Consent
Little Dreamers
Little Dreamers is Australia’s leading Young Carer organisation, working with young people 4 - 25 who provide care for a family member affected by disability, chronic, serious or mental illness, addiction or frail age.

Our programs are funded through the Care Gateway, at no cost to the school or community venue, and they typically run for between 4 and 8 weeks in either a group setting with common goals or individual sessions which are Young Carer led.

Peer Support
Our Peer Support program offers a safe and inclusive group environment where Young Carers can connect with a focus on personal development, identity and shared lived experiences.

Coaching
Our Coaching program empowers Young Carers to identify goals and implement new strategies to support their own wellbeing within their caring role as they balance their own needs with the needs of the people they care for.

Counselling
Our Counselling program provides a safe, supportive, and confidential space where Young Carers can explore their thoughts and feelings, build resilience, and develop strategies to manage life’s ups and downs..

Carer Gateway
The Carer Gateway is an Australian Government funded initiative, designed to give carers access to support at critical points in their caring journey. Little Dreamers is a Carer Gateway consortia partner. Please note, the Young Carer will be required to register with the Carer Gateway to participate in this program
Young Carer Full Name*

First NameLast Name
Birthdate*

DayMonthYear
Date
MaleFemaleTransgenderDiverseNon-BinaryPrefer not to say
Yes
Which school / tertiary institution / homeschool currently enrolled in:
Contact Phone Number*
If Young carer is under the age of 16 please enter parent or guardians numberFormat: (0000) 000-000.
Contact Email*
If Young carer is under the age of 16 please enter parent or guardians email
Home Address*

Street Address

Street Address Line 2

CityState

PostcodeCountry
Parent / Guardian Name*

First NameLast Name
Relationship To Young Carer*
Parent / Guardian Phone Number*
Format: (0000) 000-000.
Parent / Guardian Email*
About The Caring Role
Sibling (Brother)Sibling (Sister)Carer for parent (mother)Carer for parent (father)Carer for grandparentPartnerOther family memberNon-family
Physical disabilityIntellectual disabilityMental HealthAddictionNeurodivergentAutism Spectrum DisorderCancerSerious injuryChronic illnessDegenerative DisorderGlobal Developmental DelayGenetic DisorderAcquired Brain InjuryFrailty/Old AgeCarer of siblings due to parent unavailabilityOther
Emotional support and companionshipHousehold tasks (eg: cooking/cleaning/laundry)Administering medicationBathing and hygieneCommunicating on behalf of the care recipient (eg: for care recipients who speak a language other than English, or who are deaf, have a speech disorder, or are unable to write/type etc)Financial supportMedical care (eg: arranging appointments/ensuring therapy treatments are followed etc)Mobility assistance (eg: transferring from bed to chair, or assisting with walking etc)Other
Education eg: missing days of school, difficulty focusing, lack of support from teachers etcEmployment eg: reduced hours of work, inability to commit to set hours, cancelling shifts etcMental health and wellbeing eg: stress or anxiety caused by caring role, or having an unwell family member, feelings of isolation, or stigma associated with being a Young Carer etcSocialising eg: unable to engage in outside of school activities, difficulty making friends or having friends over etcNot applicable / does not impact meI prefer not to sayOther
Services Australia / Centrelink payment (including Carer Allowance, Youth Allowance, Disability Support Pension etc)NDISCarer GatewayYoung Carer BursaryI prefer not to say
Referral from schoolWord of MouthSearch engine (Google etc)Social MediaEventA poster or flyerNews articleI prefer not to sayAnother Young CarerOther
Yes
Please Share Your Name, Organisation and Contact Details:
Consent & Waiver

I consent to the above-mentioned child participating in Little Dreamers Programs and being referred to the Carer Gateway, if not already registered.

I agree that Little Dreamers, its employees, officers, agents and contractors can keep a record of information provided regarding any family member's illness, medical story and participation in Little Dreamers’ activities (‘Story’).

I have also read and agree with the Little Dreamers Consent Waiver.
I am a Young Carer consenting on my own behalfI am a Parent/Guardian consenting on behalf of my childI am a School Personnel, consenting on behalf of a parent/guardian expressing verbal consent on behalf of their child.
Young Carer Consent

I am signing this consent form on my own behalf. I am 16 or over.
Signature

Clear
Date

DayMonthYear
This is Read Only
Hour MinutesAM/PM Option
Parent/Guardian Consent

I am signing this consent form on behalf of my child or legal ward, as their parent and/or legal guardian. Accordingly, all references to "I', 'me', 'my' or similar in this form insofar as they relate to images, recordings, story, full name or similar shall be taken to be references to my child or legal ward.
Parent/Guardian Name
Signature

Clear
Date

DayMonthYear
This is Read Only
Hour MinutesAM/PM Option
School Personnel Consent

I am signing this consent form on behalf of the parent / guardian of the above-mentioned child. Accordingly, all references to "I', 'me', 'my' or similar in this form insofar as they relate to images, recordings, story, full name or similar shall be taken to be references to the above-mentioned child. I acknowledge I have discussed with the Young Carer’s parent / guardian that their child will participate in Little Dreamers Peer Support Program and will be referred to the Carer Gateway, if not already registered.
School Personnel Name
Signature

Clear
Date

DayMonthYear
This is Read Only
Hour MinutesAM/PM Option
Any additional comments?
Should be Empty:

IPPS and Coaching Programs: Application & Consent

About The Caring Role

Consent & Waiver

Young Carer Consent

Parent/Guardian Consent

School Personnel Consent