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Engagement Request Form - EVENTS
We can set up an Information Booth at your next event with resources, merch and interactive activites.
headspace Cannington receives lots of requests and we will do our best to attend whenever possible. Please provide at least three weeks notice for any event so we have enough time to prepare and secure adequate resources. You will be contacted soon after headspace has received your request.
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* Indicates required question
Name of school / organisation
*
Your answer
Address of the event
*
Your answer
Contact name
*
Your answer
Contact phone number
*
Your answer
Contact email address
*
Your answer
What is the best way for us to contact you?
*
Email
Phone
Other:
Tell us a bit more about your event...
Your answer
Date of event
*
Your answer
Start time of event
*
Your answer
End time of event
*
Your answer
Target Audience
*
Young people 12 - 18 (all years)
Young people 11-12 (year 6)
Young people 12 - 13 (year 7)
Young people 13 - 14 (year 8)
Young people 14 - 15 (year 9)
Young people 15 - 16 (year 10)
Young people 16 - 17 (year 11)
Young people 17 - 18 (year 12)
Young people 12 - 25
Young people 18 - 25
Parents and/or carers
Staff
Service providers
Other:
Required
Approx number of attendees
Your answer
Is there anything else we should know about the audience? (e.g. LGBTIQA+, CaLD, Aboriginal and Torres Strait Islander, young parents, disability...)
Your answer
Any specific issues you would like us to bring information and resources on? (tick all that apply)
Alcohol & drugs
Anger
Anxiety & Depression
Bipolar Disorder
Relationships &Conflict
Disordered Eating & Body Image
LGBTIQA+ (sexuality and gender)
Grief and Loss
Psychosis
PTSD
Self Harm
Screen time & Gaming
Tips for a healthy headspace
Exam & Study Stress
Other:
Will the event be indoors or outdoors?
*
Indoors
Outdoors
Equipment you can supply (tick all that apply)
Table x1
Marquee
Chairs x2
Shaded area
Other:
Equipment we will need to supply (tick all that apply)
Table x1
Marquee
Chairs x2
Other:
Please describe parking options at the event location (e.g. visitor bays, paid street parking, overflow parking)
*
Your answer
Additional information or comments.
Your answer
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