Inclusion Cricket Program Expression of Interest Form
Join us for a free, fun, inclusive cricket program suitable for people with a disability or additional support needs. All equipment provided.

Dates: Wednesdays from 25 October , 5.30 - 6.30pm
Venue: Ryder Oval, 750 Park Street Parkville
Contact: Zoe 0431745297 or zsharman23@gmail.com

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What's your name? *
Your email address *
Your mobile number *
What's the name of the child who might participate? *
Do you require an interpreter or assistance to complete this form? *
What's your relationship to this child? *
What is your child's country of birth? *
Where was the child's mother born? *
Where was the child's father born? *
Is a language other than English spoken at home? If yes, what language? *
Does your child have any medical conditions or allergies? *
What are your child's preferred pronouns?
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Your child's date of birth *
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What best describes your child's cricket experience? *
What school does your child attend? *
What other physical activities does your child enjoy or has been involved in? *
Required
Does your child have any of the below diagnoses? *
Required
How does your child generally communicate their wants and needs? 
What are things your child enjoys doing? What are their favourite things? *
What are things that your child tends to avoid or finds challenging?  *
What are you hoping for your child to get out of the Inclusion Cricket Program? *
Welcoming Australia Media Consent

I hereby consent and agree that Welcoming Australia has the right to take and use photographs and videos of me, including online, for purposes including internal use and external promotional and marketing material.
I hereby release to Welcoming Australia all rights to exhibit this work in print and electronic form publicly or privately and to market copies. I waive any rights, claims or interest I may have to control the use of my identity or likeness in the photographs taken by Welcoming Australia and agree that any uses described may be made without compensation or additional consideration of me. We will not use any photos without permission from the participant (if over 18 years) or the parent/ caregiver (if under 18 years)

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Participation Consent and Consent to Share Information

As a participant in a Welcoming Australia program, we need your consent to work with you. In order for us to provide you with the best support we can, we may need to record information about you, including your name, date of birth, ethnicity, visa, disability needs and so on. We do not share this information with any other organisations without your consent, and all information is kept in a secure file. To be able to support you in this program, we need your consent to share your information in order to communicate and register with relevant sporting and recreational clubs and organisations.

From time to time we are required to provide reports to our funding bodies on the progress of the program. We will use some of your information in these reports, but never in a way in which you can be personally identified.

The only time we will ever share your information with another organisation is if we have serious concern for your safety, or the safety of others. The kinds of people we would share information with in this instance would be ambulance, fire and police services.

You have the right to complain about the service you receive from Welcoming Australia, and we welcome all feedback. To make a complaint or provide feedback please contact the Welcoming Clubs Manager Maia Tua-Davidson at Maia@welcoming.org.au
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Is there anything else that would be important for us to know about you or your child?  *
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