• Intake Form – Elevate Capacity™ Generic

    Please complete this intake form so we can learn about your background, goals, support needs, health and safety considerations, consent preferences, and participation interests. Thankyou!
  • Participant Information

  • Format: (000) 000-0000.
  • Referral Information

  • How did you hear about this workshop or Elevate Capacity?*
  • Participant Goals & Interests

  • What outcomes do you want most from participating?
  • What would you most like support with?
  • Support & Accessibility Needs

  • Do you have any support needs we should be aware of?
  • Health & Safety Information

  • Consent & Agreement

  • Acknowledgement
    I acknowledge that I am voluntarily participating in an Elevate Capacity™ workshop, program, coaching session, or event.

    I understand that Elevate Capacity™ provides education, information, mentoring, and capability-building activities related to health and wellbeing, life skills, entrepreneurship, employment readiness, and personal development.

    I understand that:

    Participation is voluntary.

    I am responsible for my own decisions, actions, and wellbeing during and after participation.

    Information provided is educational in nature and is not intended to replace medical, psychological, legal, financial, or other professional advice.

    I will seek appropriate professional support where required.

    I may choose not to participate in any activity that makes me uncomfortable.


    Health & Safety
    I confirm that I am physically and mentally capable of participating in the activities offered and will advise the facilitator of any relevant conditions that may impact my participation.

    I understand that while reasonable care is taken to provide a safe environment, participation may involve physical activities, group discussions, and practical exercises.

    Release of Liability
    To the extent permitted by law, I release and hold harmless Elevate Capacity™, its facilitators, employees, contractors, volunteers, and partner organisations from any claim, loss, damage, injury, or expense arising from my participation, except where caused by negligence.

     

    Confidentiality & Respect
    I agree to:

    Treat all participants with respect.
    Maintain the confidentiality of personal stories shared by others during the program.
    Contribute to a safe and supportive learning environment.

  • Photography / Media Consent*
  • Email and Marketing Consent*
  • Participant Details & Signature

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Facilitator Notes (Internal Use Only)

  • Should be Empty: