Application Form - Member

Application Form Member New

Thank you for your interest in Upbeat Arts.

If you are NEW to Upbeat Arts and would like to join one of our programs – please complete this form.

If you’re already attending our programs, or have previously been a member with Upbeat Arts, please contact us on 07 3073 2919 before completing this form.

• The email address for the new member of Upbeat Arts provided on this form must belong to the individual applying to join.

• Support/care team – should you either not have an email address for your client or there isn’t one, please contact us on 07 3073 2919 before completing this form.

On receipt of your application, we’ll check availability of your chosen program and be in touch with you via the email you have provided. You might need to check your junk/spam folder for your email – sometimes they will hide there.

Our programs are free to access and are delivered for the benefit of adults experiencing a mental illness, or anyone disadvantaged or marginalised. Please include details of the person and organisation who has referred you (and/or supports you), ie Queensland Health; the Agency or Service you are working with or being supported by; or a medical professional.

This Upbeat Arts Application Form collects information to assist us to place you into one of our programs. All information will be treated confidentially and will not be used for any other purpose than what is stated in our Privacy Policy.

Tell us a little about you

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Email(Required)
The EMAIL ADDRESS supplied here for the new member becomes the USER NAME for this member – so must be unique to the person registering to be a member. Therefore, it’s important to use a personal email address.
Support workers completing this form on behalf of a client: if you don’t know or don’t have an email address for your client, please make contact with us (07 3073 2919) before completing this form.
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Do you identify with any of the following?
Aboriginal
Torres Strait Islands
Culturally or Linguistically Diverse
LGTBQI
None of These
Prefer Not to Say
Cultural Identity – Other

Medical Information – (Please indicate any of the following which apply)*

Anxiety
Depression
PTSD
Dissociative Identity Disorder
Bipolar
Schizophrenia
Intellectual Disability
Acquired Brain Injury
Addictions
Autism
Eating Disorder
Medical Background – Other
Please choose the answer that best describes where the majority of any support you receive comes from.

Food Allergies*

Gluten Free and Celiac
Dairy and Lactose Free
Nut Allergies
Seafood Allergies
Food Allergies – None
Food Allergies – Other

Which program/s would you like to register for?

Program Choice(Required)
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For our records

Referrer details

Some examples:

• Agency might be Footprints, Open Minds, RFQ, or another similar service.

• Qld Health Service would be any of the public health system services.

• Medical Professional might be your GP or Psychologist.
IE this might be Open Minds, RFQ, Queensland Health, your GP or Psychologist or an NDIS provider etc
If you don’t have one, please type none

Emergency Contact Details

We’ll be in touch to confirm your place. Look out for an email from us. If you don’t see it, check your junk/spam folder.

By submitting this form, you understand you’ll be added to our database for the purpose of sharing emails about your program/s.

By submitting this form, you understand we may contact the numbers you’ve shared, if we are concerned about your well-being whilst you are in attendance at one of our programs.

You’re now ready to hit the ‘SUBMIT’ button below.
This field is for validation purposes and should be left unchanged.