• Hopestreet Social Mentor Groups Consent Form

    This form provides us with important information to ensure every young person has a safe and positive experience. Please complete all sections. A parent, carer or guardian must complete this form with the participant if the participant is under 18 years of age unless they are classed as independant.
  • Participant Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Medical Information

  • Does the participant have any medical conditions?*
  • Does the participant have any allergies?*

  • Permissions

  • I authorise Hopestreet staff to seek medical treatment in the event of illness or injury if I cannot be contacted.

  • Medical Treatment*
  • Independent Travel*

  • Photo & Media Consent

  • Hopestreet celebrates participant achievements through newsletters, social media, grant reports and promotional material.

  • Photo & Media Consent*

  • Privacy Statement

  • Information collected is used for program delivery, duty of care, funding reporting and communication with families. Information is stored securely by CareWorks Inc. and will not be shared without consent unless required by law.

  • Behaviour Expectations

  • Participants agree to:

    • Treat everyone with respect
    • Follow staff directions
    • Maintain a safe environment
    • Respect equipment and property
    • No drugs, alcohol or vaping during program hours
    • Use appropriate language
    • Participate safely

  • Risk Acknowledgement

  • I (the parent/guardian and participant) understand that:

    • Activities may include cooking and working in a kitchen.
    • There are normal kitchen risks including hot equipment, cleaning products and manual handling.
    • Hopestreet staff provide supervision and safety instruction.

  • Communication Consent

  • Communication Consent*

  • Participant Declaration

  • Hopestreet Social aims to provide a safe and supportive environment for everyone. I understand that Hopestreet may suspend or end my participation if my behaviour places me or others at risk, if I repeatedly breach program expectations, or I prevent the safe operation of the program. Wherever appropriate, this will be discussed with me and/or my parent or guardian first.

    I understand the expectations of the Mentor Group Program and agree to participate safely.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Parent/Guardian Declaration

    • The information provided is accurate.
    • I understand the nature of the program.
    • I give permission for my child to participate.
    • I understand Hopestreet staff will provide reasonable supervision.
    • I understand that participation may involve cooking or other kitchen based activities.
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: