1. MENTORING PROGRAM DETAILS



2. PARENT/GUARDIAN DETAILS









3. PARTICIPANT DETAILS

Official name as written on class roll

As written on class roll

The name they prefer to be called. 



DD/MM/YYYY


4. PROGRAM PARTICIPATION CONSENT
I consent to my young person’s participation in the I CAN program. I have been informed by I CAN Network/my young person's school of the arrangements made for the conduct of this program.  

Expenses:

  • I agree to my young person’s returning home if necessary in the event of illness, injury or non-cooperation, and to pay any expenses involved or to come and collect my young person from the I CAN program.
  • I agree to reimburse I CAN Network for any wanton damage caused by my young person.
  • I agree to reimburse I CAN Network for any hospital, medical or ambulance expenses incurred by I CAN Network on behalf of my young person.

5. PARTICIPANT HEALTH AND FURTHER INFORMATION




Max 50 words

Max 100 words

Max 100 words








6. PARENT PRE-PROGRAM SURVEY CONSENT
We run surveys with parents to check how their young person is feeling before and after the program. Data from these surveys helps us see whether mentoring programs are run at a high standard, whether we are achieving outcomes among Autistic young people and identify how we can improve our programs. This survey will collect information on how your young person is feeling before the program is starting. Participation in this survey is completely voluntary, and you can choose to withdraw at any time by not completing the survey. Should you have any questions about the survey, please email us at evaluations@icannetwork.com.au
Would you like to complete a survey about your young person?

Please select the response which is the closest to how your young person is feeling.

If you do not understand the statement, please choose the ‘I don’t understand the question’ option.


My young person.....

Strongly Disagree Disagree Unsure Agree Strongly Agree I don’t understand the question
7. PARTICIPANT PROGRAM SURVEY CONSENT 

We value young people’s opinions about how we deliver our programs. With your consent , we will ask your young person if they would like to do a similar voluntary survey during their I CAN Schools Mentoring program.


If they agree, their answers will be anonymous and kept secure, accessed only by authorised I CAN Network staff and used only for investigating the quality and social impact of our programs.

8. MULTIMEDIA CONSENT TERMS & CONDITIONS

Use of adhoc photos/videos/audio/statements obtained during the mentoring programs for the promotion of I CAN Network, its programs and events.


As part of our programs we may take photographs or videos, or collect written comments or audio, of activities in which your young person is involved. 


These photos, videos, audio, and written or verbal statements may be used to promote the I CAN Network in our publications, leaflets, as well as our website, blog and social media. 


Consent will be deemed indefinite until revoked. Under I CAN Network Ltd’s Privacy Policy, I can opt-out of my/ my child’s preferred name, video image/ recording, written comments and audio being used for I CAN Network’s social media/ marketing at any time, by emailing the Privacy Officer at privacy@icannetwork.com.au.  


Photographs and media are classified as personal information under the Information Privacy Act 2009. I CAN Network Ltd respects your privacy and therefore requests your permission to photograph and/or video your child or collect their written comments or audio. The image(s), recordings and written comments will remain the property of I CAN Network Ltd. It will be assumed that your consent is given for an indefinite period of time or until you withdraw your authorisation.


It should be understood that material published on the Web (inclusive of social media including YouTube) will be accessible to people worldwide and that the information can be copied and used by any Web user. I CAN Network Ltd has no control over the subsequent use and disclosure of information on its website once that information is published.


Please note: Multimedia consent is completely voluntary. Your young person will not be disadvantaged should you choose to decline consent. 

9. ICT ACCEPTABLE USAGE TERMS & CONDITIONS

I CAN Network has standards of behaviour to make sure our online spaces are safe and inclusive. This applies to I CAN School sessions held onsite or online via Zoom or Microsoft Teams.  


These standards are outlined in our Information and Communication Technologies Acceptable Usage Agreement.


That agreement includes the following responsibilities:

  • To communicate with respect and kindness at all times, both to themselves and to one another.
  • To join group discussions when possible and to give space to their peers to contribute.
  • To refrain from sharing any posts, links, or images etc that are rude, inappropriate, or irrelevant to the session.
  • To refrain from sharing personal information, including screenshots of conversations or social media.

Thank you for completing this form. 
If you have any difficulties with completing this form, please email our team and they will be able to assist you.  If you would like to learn more about our other programs or to find downloadable resources to support your young person please visit I CAN Network.