2022 Application Form - Participant (Queensland)

 
Thank you for your interest in Upbeat Arts Queensland. To apply to be a member of one of our programs, please complete 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 provide below.
 
Our programs are free to access and are designed 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.
 

Important Information regarding Covid-19

 

Upbeat Arts is committed to continuing to provide our arts programs in Brisbane. With changing health directions, we may have to amend the way we deliver our programs. Our members are kept up to date at all times. 

Please note any interaction with the general public poses an elevated risk of being exposed to COVID-19 and we cannot guarantee that you will not be exposed while attending our programs. You should seek your own medical advice prior to attending, and consider your individual situation.

Members attending 'face to face' programs need to be fully vaccinated against COVID-19. This is in line with current public health advice and also allows us to comply with the rules of the venues we use.

Members attending the 'online' creative writing program do not need to be fully vaccinated or provide this information.

 

A little about you

Name:

Please choose from the drop down list

Tick any that apply and/or add 'other'

Choose from the drop down list

 

Program Selection

Choose one or more

 

For our records

Choose from the drop down list

 

Referrer details

Mobile required if wishing to receive weekly text reminders on behalf of client (see below)

This isn't a requirement, but an added service if you wish to be kept up to date with program activities.

Please choose from the drop down list

 

COVID-19 VACCINATION STATUS

 

Members attending 'face to face' programs need to be fully vaccinated against COVID-19 - minimum of two doses. This is in line with current public health advise and also allows us to comply with the venues we use.

Members attending the 'online' creative writing program do not need to provide this information.

 
We understand that members may feel this measure contradicts with their own personal health choices. We acknowledge this. If you wish to make a complaint please email info.qld@upbeatarts.org.au
 

Emergency Contact Details

Emergency Contact Name:

 

Thank You!

 
Please look out for your welcome email. You may need to check your spam/junk folder for an email from susan.gilmartin@upbeatarts.org.au. Please add this email to your safe sender list.
 
You will be sent important information about your weekly session via text or on the email address supplied here - please ensure you monitor incoming messages/emails the day prior to each session.
 
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.
 
In submitting this form, you consent to Upbeat Arts liaising with your support team and/or emergency contact if required in relation to your involvement with Upbeat Arts.

Please tick to verify that you are not a robot

 

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