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. PARTICIPANT PROGRAM SURVEY CONSENT 

I CAN Network Ltd. runs paper and online surveys with young people to collect their opinions on the mentoring programs. We do this to measure the quality and social impact of our mentoring programs and to generate evidence behind a strengths-based approach to Autism. Participation in these surveys is voluntary; your young person does not have to complete the surveys if they do not want to.

Survey responses will be stored on a secure server and only made accessible to authorised I CAN Network staff. Survey responses are also anonymised, so your young person cannot be identified. Furthermore, any quotes from survey responses will be reported under a generic descriptor (e.g., mentee).  


Would you like to give consent for your young person to complete the surveys during the program?

7. 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. 

8. 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.

9. REGISTRATION FOR AWETISM 23

10. USE OF FULL NAMES AT AWETISM 23 

11. AWETISM 23 VIDEO SHOWCASE PARTICIPATION CONSENT

Some young people in our programs express a desire to make a video of their I CAN program for AWETISM. These videos can either be recorded by the young person themselves, by the I CAN team via Zoom or during an I CAN mentoring session via an iPad.


In the event that your young person would like to contribute a video themselves or participate in a video showcasing their school’s program, we ask for your consent for your young person’s contribution to be filmed and released at AWETISM 23 on awetism.vfairs.com, and on the I CAN Network YouTube page at www.youtube.com/theicannetwork. 

12. AWETISM 23 MULTIMEDIA CONSENT

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.