Register Your Interest – School Holiday Consent Form

Children's/Young Person's details:

Parent/Guardian details:

Confidentiality is a right for anyone attending counselling at HelpingMinds. Information disclosed during sessions is strictly confidential. Notes written after each session are kept in a secure location. Support workers may discuss information with their supervisor and peers for the purpose of professional supervision and continuous improvement. Support Workers have a duty of care to break confidentiality if they believe that the person receiving counselling is at risk and/or at risk of harming themselves or others. At times case files can be subpoenaed by court. In these instances HelpingMinds may be obligated to hand over case files. In some instances support workers are required by law to inform authorities if they have been given information about past, present or future crime(s).

This program may use an external activity provider/venue provider which requires an external consent/permission form to be completed by the parent/legal guardian before the child can start that activity.

Our School Holiday Programs are funded by the Mental Health Commission and Department of Social Services. Please read the below information regarding how your information may be used.

The information you provide on this form may be requested and used by the MHC for the purpose of research, analysis and evaluation of this service. This data will assist the MHC regarding the quantity and kind of assistance needed in the community as well as improving the delivery of the service.

For our Department of Social Services funded programs the client information management system we are obliged to use is an IT system called the Data Exchange which is managed by the Australian Federal Government. Your personal information which is stored by the Department of Social Services (DSS) on the Data Exchange will only be disclosed to use for managing your case. The Department de-identifies and aggregates data within the Data Exchange to produce information for policy development, grants program administration, research and evaluation purposes. This includes producing reports for sharing with service providers. This information will not include information that identifies you, or information that can be used to re-identify you, in any way. You can find more information about the way the Department will manage your personal information in the Department’s Australian Privacy Principles (APP) policy which the Department has published on its website. The policy contains information about how you may access the personal information about you that is stored on the Data Exchange and seek correction of that information. This policy also includes information about how you may complain about a breach of the APP by the Department, and how the Department will deal with your complaint.