WOW Program - Registration and Consent Form

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Please complete the following form in order to confirm your registration and consent to participate in this program:

Email *

Your name: *

Surname *

Your date of birth: *

YYYY

How did you hear about WOW workshop? *

GEM Coaching Consent:

GEM Connect Pty Ltd is a social enterprise that works to provide psychosocial support to people from all walks of life. GEM provides an education program, as well as access to an online network, that supports people to connect to other like-minded individuals, resources, and services in the community.

> Personal information (which includes health information) is of a highly sensitive nature. We are committed to respecting your right to privacy and confidentiality. As an Australian-based company, we are obligated to protect your personal information under the Privacy Act 1988 and the related Australian Privacy Principles 2014.
> We may collect personal information that is reasonably necessary for purposes directly related to the functions or activities of our service.
> Your personal information and answers to our questionnaires may be used by our Coaches for education coordination and service delivery. It may be reasonably necessary in the provision of your GEM Coaching for your personal information to be exchanged between our Coaches and with our Management Team.
> Your de-identified personal information and answers to questionnaires may be used for related research purposes; that is, in the collection of data for the creation of academic articles or position papers advocating for the usefulness and effectiveness of the education service provided by GEM Connect Pty Ltd.
> GEM Connect Pty Ltd is a Coaching service, and not a mental health service/provider. If your Coach has any concerns about your mental health during the time of your engagement with GEM Connect Pty Ltd, this may be shared with our Management Team for the assistance of a mental health referral as part of our Duty of Care.
> We will only use your personal information for purposes for which it was collected, unless you have consented to its use for another purpose, or it is permitted or required by law.
> We will not disclose your personal information to third parties without your consent, unless required or permitted by law.
> Subject to some exceptions permitted by law, you have a right to access your personal information and you can speak to your Coach if you wish to do so.

Please tick all of the following: *

I understand that this coaching with GEM Connect Pty Ltd is voluntary, and any coaching delivered is subject to informed consent, and in accordance with any relevant legislative requirements.

I understand that GEM Connect Pty Ltd may collect and use my personal information as is deemed reasonably necessary for the course and outcomes of their coaching outcomes.

I understand that GEM Connect Pty Ltd may use de-identified personal information for the purposes of related research and to advocate for the usefulness and effectiveness of the education service provided.

I understand that if I choose to withdraw this consent at any time, I must do so in writing via email to mu Coach at GEM Connect Pty Ltd and not my employer.

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