Consent Form

What is this form about? 🤔

Before you can take part in this project we need your consent. 

It is important that you understand what you are agreeing to before you sign this form.  

If you have any questions, or you don’t understand something, make sure you talk to someone about it. This might be Sam, Leanne, or an adult you trust.  

My Consent

I can make sense of the Information Sheet(Required)
(You can read the info sheet here:
I know I do not have to answer questions or talk about anything that I don’t like or I don’t want to answer.(Required)
I know it is ok to stop being a part of the project at any time. It will not affect my relationship with CCYP.(Required)
I know that if I have any questions about the project, I can ask Leanne, or Sam, or someone else from the project team.(Required)
I understand and agree that my name, age, gender, and which region of the state I live in will be provided to the organisations that are providing support to Council members (SASS and Laurel House).(Required)
I know that if anything in the project makes me upset, I can ask for and will receive support.(Required)
If I say I would like some extra support, it is ok for CCYP to ask SASS or Laurel House to contact me, and give them my contact details to make this happen.(Required)
It is ok for CCYP to use what I say or make in their work – I know they will not use my real name unless I ask them to.(Required)
I know I can talk to Leanne, Sam or another member of the project team if I change my mind and don’t want what I’ve said or made to be included in the project.(Required)
I understand that CCYP, SASS or Laurel House won’t share any of my private information or personal details, unless I say or do something that makes them concerned about my safety or the safety of someone else.(Required)
I agree to being recorded and understand that the recording will be kept confidential and will only be used to check that no mistakes are made in recording what I say.(Required)
I understand that: I will be sharing my views as part of this project, I can choose to do this in person or online or by phone, and I will have a choice about how many times and how often I participate.(Required)
I agree to being part of this project.(Required)

My Signature

About Me

Think about the kinds of things that will make you feel more comfy, or things like allergies and foods that you really like to eat (or foods that make you sick!)… or anything else that we can do to make it easier for you to take part!

Emergency Contacts

Please include the details of at least one person Sam or Leanne can contact in the unlikely event that there is an emergency.

If you want to tell us more, send us an email or you can call Sam on 0460 041 402. 

Keeping Your Information Safe 

We collect some information from you to make sure it’s OK to record your voice and use your quotes in the things we make, like books or online posts. We will take care of your information and follow the rules in the Personal Information Protection Act 2004. 

If you ever want to see the information we have about you, you can contact us by emailing or by phoning us on (03) 6166 1366.