Personal Information Form (Members)

Personal Information Form - Members

This field is for validation purposes and should be left unchanged.

Let's finish the paperwork!

Upbeat Arts is delighted that you are enjoying our programs. We ask that you take a few minutes to complete this form.

You're being asked to complete this form for one of two reasons: You're recently joined us or it's been quite a while since you updated this information.

Thank you for taking the time to do this.

NEED HELP? If you need assistance completing this - please ask someone to help you or ask us. We're very happy to help. We get it - forms can be a little daunting. We can help you next time you are in at your program.

A friendly reminder that it is your responsbility to keep Upbeat Arts updated with any changes to the information provided here. All personal information collected by Upbeat Arts Ltd is confidential. You may access your own personal records at any time. Upbeat Arts Ltd abides by the National Privacy Act.

This field is hidden when viewing the form

sharpspring_base_uri

This field is hidden when viewing the form

sharpspring_endpoint

Member Personal Contact Information

Name

First Last

Email(Required)

Enter Email Confirm Email

PLEASE USE THE EMAIL ADDRESS WE HAVE EMAILED THIS FORM LINK TO - THIS IS YOUR USER NAME WITH UPBEAT ARTS. It's important that you use the email address you used previously on the Member Application Form - as this is your 'USER NAME' with Upbeat Arts. If unsure, please call us to check before completing this form.

Street Address

This field is hidden when viewing the form

Address Line 2

Suburb

Post Code

How can we best support you?

* Please indicate any things on this list that may make you uncomfortable during your Upbeat Arts program (tick all that apply)

Loud or sudden noises

People behind me

Anxiety about performing

Anxiety about performing (this is always your choice)

Stating my opinion

Starting conversations

Being touched

Worrying about mistakes

Worrying about making mistakes

Some song lyrics

Some song lyrics (if applicable to your program)

Uncomfortable - None of the above

None of the above

Uncomfortable - other

Other

If you ticked other, what else would make you uncomfortable?

* What might help you to feel more settled (tick all that apply)

Deep breathing

Stepping out of the room for a while

Talking to some-one

Some time-out alone/giving me some space

Massaging my hands

Running cold water over my hands

Moving / stretching

Activities on my phone

Having my concerns acknowledged

Reminding me of my helpful strategies

Not applicable to me

* Do you need help with any of the following? (tick all that apply)

Help - mobility

Mobility

Help - Reading

Reading

Help - Writing

Writing

Help - Hearing

Hearing

Help - Getting on and off stage

Getting on and off stage

Help - Nothing

Nothing

* Are there any skills, qualifications or talents you'd like to share with us

Through your attendance at our programs, what would you like to achieve over the next twelve months. (tick any that apply)

Achievements - Artistic

New artistic skills (i.e. singing, acting, writing, song writing)

Achievements - Social Connectedness

Increased social connectedness

Achievements - Increased confidence

Increased confidence

Achievements - Increased self-esteem

Increased self-esteem

This field is hidden when viewing the form

Status

Media Statement

From time to time Upbeat Arts Ltd trading as Upbeat Arts may commission or require that photographs, videos, and/or audio clips of any Upbeat Arts programs and their members be created ("Materials").
Upbeat Arts requests the right and consent to use the Materials in relation to the provision of its ongoing community programs and activities. The Materials may also be used in relation to the reasonable promotion and publicity of Upbeat Arts programs and activities and its fundraising and sponsorship activities. Such use may include, for example, use of the Materials in brochures, posters, flyers, website, press releases and newspaper and television news and current affairs programs.
By signing this form, I agree with Upbeat Arts and otherwise consent as follows:
1. That Upbeat Arts may use the Materials in the manner set out above.
2. That Upbeat Arts may use my First Name in connection with the above use.
3. That there will be no financial compensation for any such use (including any royalty payments).
4. That Upbeat Arts may authorise others to use the Materials provided that their use shall be consistent with the terms of this release and consent.
5. I agree that the photographs/video and/or audio remain the physical property of Upbeat Arts. Any further use of the Materials (eg in relation to any book, publication or television program on a commercial basis) shall be subject to a further agreement between Upbeat Arts and myself.

Media Release(Required)

I understand and agree to the terms and conditions of the media release above

I would prefer that individual photos/videos of me are not taken or shared (refer 1 below)

No, I do not agree to having my photo taken at all (refer 2 below)

(1) However, I understand that by attending my program, I may be included in the background of photos/videos of group activities and performances. (2) We respect your rights completely, and we’ll speak to you individually to ensure you understand that when there are cameras around, we’ll ask you to step aside for a short time if needed. At public performances/engagements we cannot guarantee that your photo won’t be taken.

Our Behaviours

'Our Behaviours' are guidelines on how to behave as a member of Upbeat Arts. In conjunction with the Member Handbook which you received a link to as part of your Welcome email. Please read this thoroughly and think about what it means before you agree to abide by it.

By agreeing to the points within 'Our Behaviours', you agree to follow these guidelines and understand that we will speak with you if we feel you are not abiding by them. If required, we may issue a verbal or written warning, or in extreme situations, suspension or expulsion from your program may result.

* Respect and Kindness

We are respectful of each other’s rights and beliefs and always speak with kindness and an open heart.
We refrain from negative or hurtful comments. We are inclusive and accepting of everyone – knowing we are all equal.
If we have a concern about something to do with our program or another person, we’ll speak with the program leader directly.
We know that aggressive verbal or physical bct and kindness
ehaviour is not ok.

* Doing our best and having fun

We’ll attend our program regularly and know that as long as we do the best we can, that’s ok. If we can’t make our program, we’ll do our best to let Upbeat Arts know.
We’ll be clean and sober at all Upbeat Arts programs, performances and events.
Having fun is key. We’ll learn, meet new people and enjoy the journey we’re on.

* Inspire Others

Be a role model by demonstrating a positive attitude, resilience, dedication and a willingness to learn and grow.
Be a good listener by showing a genuine interest in others and hearing their thoughts, feelings and experiences.

Our Behaviours(Required)

I agree to respect myself and other members, staff and volunteers and will abide by the behaviours of Upbeat Arts

CAPTCHA

THANK YOU - you did it!

We appreciate you taking the time to complete this information, which is a requirement for all members of our Upbeat Arts programs.
Don't forget to hit the 'SUBMIT' button below.