KGI - REAL Healty Program Application Form
 
 
About the REAL Healthy Program:
 
 
REAL Healthy is an extension of the REAL Program focussing on the key pillar of Health & Well-being creating opportunities for Indigenous youth to become more aware of their own Health & Well-being. The REAL Healthy program will also incorporate other key areas, Cultural Connection, Leadership skills and Career aspirations during the roll out of the program.

The REAL Healthy program will take place in local communities over the year supporting and guiding existing Health & Well-being programs. Our target audience is Indigenous Youth, 13 years and up and the facilitation of the program can be tailored to school or community groups depending on the size of the group, age and needs. The sessions are delivered by KGI staff, Indigenous facilitators, and KGI program alumni of young Indigenous people.

Any questions regarding the program please contact Brady Cooper (Program Lead) bcooper@richmondfc.com.au or Dylan Murphy (Program Officer) dmurphy@richmondfc.com.au
 
PARTICIPANT PERSONAL DETAILS
Firstname *
Surname *
Address *
City *
State *
Postcode *
Phone *
Email *

DOB *
Gender *


PARENT/GUARDIAN DETAILS
(Only required if you are under 18 years of age)
I am currently aged 18 or over   

Firstname *
Surname *
Address *
City *
State *
Postcode *
Phone 1 *
Phone 2
Email *


EMERGENCY CONTACT DETAILS
Same as Parent/Guardian   


Firstname *
Surname *
Address *
City *
State *
Postcode *
Phone 1 *
Phone 2
Email *


MEDICAL
Medicare Number
Health Care Number
Ambulance Number & Medical Fund
Medical Conditions, Mental Illness, Physical Illness
Name any physical illness or condition (e.g. asthma, epilepsy) for which you are receiving treatment or any medications you are currently taking
Medication while on camp
Tetanus Injection Date
Allergies
Are you allergic to anything, for example Penicillin or other medications, foods, animals or bee stings? If yes, list allergies, how you react and necessary action steps
Do you have any dietary requirements?
If yes please provide details


STUDENT QUESTIONS
(to be answered by student)

Current level of education completed * 
What KGI programs have you been involved with?
Laguntas *
Lagunta Sisters *
Boorimul *
REAL Program *


1. Have you had a Health check in the last year? *
2. Are you involved in a sporting club? If so which club? *
3. What do you currently do to work on the following; i Physical Health ii Mental Health? *
4. How many times a week are you active for more than 30 mins? *
5. What sports do you currently play? *
6. Is there a new sport or physical activity that you would like to give a go? Eg Pilates, Yoga, Gym class, Spin (bicycle class at gym), Weights? *
7. Is there anything you do for your mental health currently? If not what might you want to try? *


PARENT/GUARDIAN CONSENT:
I consent to my son/daughter to attend the Richmond Emerging Aboriginal Leadership (REAL) Empowered Program at the Richmond Football Club. I give consent for the staff, leaders and facilitators involved in the program to provide guidance and instructions to the participants. By accepting this consent form I am agreeing to the participant abiding by the code of conduct below, and understand that failure to do so may lead to being sent home from the program.
 *


  1. All program participants must abide by program times and schedules and obey instructions made by the program staff.
  2. All participants are to use appropriate language at all times whilst on program.
  3. Program staff are responsible for the safety of all participants during the program. At no time is any participant to be involved in any form of violence.
  4. Any inappropriate behaviour must be reported to the KGI staff and leaders and consequences may be dealt to participants who misbehave.
  5. All participants must practice responsible use of social media, be mindful of communications with other participants and positively represent the KGI. Mobile phones are not to be used during sessions.
  6. Any accidents or injuries should be dealt with according to first aid training. All incidents should be reported to the program staff and an incident report filled out.
  7. Participants are required to wear KGI attire in a neat and tidy manner whilst on programs.
  8. Drugs and alcohol of any description are strictly prohibited on the REAL program.
  9. Participants are responsible for all personal property brought on program and KGI are not responsible for any loss or damages.


PHOTOGRAPH CONSENT
Photographs are often taken during the KGI REAL Program and can be used for promotional purposes. By consenting below, you give consent for KGI, the Richmond Football Club and program partners to use any photographs taken on the REAL Program for publicity purposes.
 *