PARTICIPANT APPLICATION FORM, Brisbane - All programs

NOTE: This form is for BRISBANE programs. Please go back and look for the REGIONAL QUEENSLAND form if needed.
Thank you for your interest in Upbeat Arts Queensland. To apply to be a member of one of our programs, please complete this form. Members will require a referral from Queensland Health, the Agency they are working with or being supported by or medical professional to confirm a mental health diagnosis. Members must reside within the greater Brisbane area in order to access our South Brisbane programs. On receipt of your application, we'll check availability of your chosen program and be in touch with you via email.
Due to the COVID - 19 Pandemic, some Upbeat Arts programs are being delivered virtually. Please check your Welcome Email for details. To ensure continuity of service post COVID-19 restrictions, the above criteria (including residing within the greater Brisbane area) is still applicable and members will also need to have access to a suitable device (smart phone, tablet, laptop or computer) and internet connection.

A little about you

Name:

Which programs - choose one or more

For our records

Referrer details

Emergency Contact Details

Name:

Thank you. Please look out for your welcome email within the next two business days. 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.

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