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TEAL Program Acceptance Form
TEAL - Program Acceptance Form
"
*
" indicates required fields
Your name
Name
First
Last
Program Acceptance Questions
Program Dates
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I agree to attend the sessions as detailed in the program offer I received
Terms and Conditions
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In consideration for the opportunity to participate in the 2021 Tasmanian Emerging Aboriginal Leaders (TEAL) program, I agree to be bound, and continue to be bound, by the Terms and Conditions published by Tasmanian Leaders which may be amended from time to time. I recognise that the Terms and Conditions impose a range of obligations on me and they also, among other things, limit any potential liability Tasmanian Leaders may have otherwise had to me. I also understand that by submitting this form and accepting a place on the 2021 Tasmanian Emerging Aboriginal Leaders (TEAL) program I am committing to paying the participant fee.
https://www.tasmanianleaders.org.au/i-lead-terms-and-conditions/
I-LEAD participant charter
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I will show professional respect to my fellow participants, facilitators and all guests of the program.
I-LEAD participant charter
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I will read any materials provided before each session and participate fully in every session I attend. Undertake any pre task activities. Complete and participate in ongoing Tasmanian Emerging Aboriginal Leaders (TEAL) evaluation as requested.
I-LEAD participant charter
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I will undertake to attend all program sessions. I understand that full benefit from the program can only be gained by full attendance and I acknowledge the expectation that participants will only be absent from program sessions in exceptional circumstances.
I-LEAD participant charter
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I will strive to actively participate in community development to influence a more successful future for Tasmania.
Let us know what details you would like on your name badge
Preferred name, role, and the company you are representing
Preferred name
*
e.g. John Smith
Role
*
Company you are representing
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Details of primary emergency contact
Name
*
Full name
Relationship to you
*
Husband, wife, partner, parent, brother, sister, etc.
Phone (primary)
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#### ### ### or landline ## #### ####
Phone (secondary)
#### ### ### or landline ## #### ####
Would you like this person to make requests on your behalf?
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Yes
No
Details of secondary emergency contact
Name
Full name
Relationship to you
Husband, wife, partner, parent, brother, sister, etc.
Phone (primary)
#### ### ### or landline ## #### ####
Phone (secondary)
#### ### ### or landline ## #### ####
Would you like this person to make requests on your behalf?
Yes
No
Medical, dietary, and accessibility
We want to ensure we are able to support your participation in the program
I have a medical condition that will impact my participation
I have dietary restrictions
I have accessibility needs to allow me to fully participate
If you have a medical condition, please detail the dates, duration and outcome of the illness or condition
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If you have dietary requirement, please detail and include dietary choices such as vegetarian/vegan
*
If you have accessibility needs, please detail things that might affect access to venues, capacity to sit for long periods etc
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Communicate and share information during the program
To enable us to communicate and share documents with you during your program experience, we will be establishing a Microsoft Teams account. To help set this up, please confirm the email you would like the account invitation to be sent to? This email will be used for log ins and notifications. If you already have a Microsoft Teams account you might like to use the same email address.
Please supply the primary email address you used to apply to the program
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The email address you received the form link from
Would you like to use the same email address for Microsoft Teams?
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Yes
No, I would like to use an alternate email
If no, please supply an alternate email address
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A little bit more information
Photo
Please upload a recent photo (headshot), this will be used to share with participants at the start of the program
File
*
Max. file size: 64 MB.
Consent
I give consent to Tasmanian Leaders to share my mobile number and email with my fellow participants
I have received COVID vaccinations
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Yes
No
I'd prefer not to say
We ere asking this question on a voluntary basis in the event that one of our venues requires us to be vaccinated.
I have a current Working with vulnerable people's card
*
Yes
No
I'd prefer not to say
WWVP card number
*
WWVP expiry date
*
https://www.tasmanianleaders.org.au/teal-terms-and-conditions/
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