KGI - REAL VEC PROGRAM APPLICANT FORM
 
 
About the REAL VEC Program:
 
 
The REAL VEC program is aimed at KGI alumni and other Aboriginal and Torres Strait Islander young people who are interested in creating content for the Victorian Electoral Commission around voting and using your voice.

Any questions regarding the program please contact Michelle Kerrin (REAL Program Lead) mkerrin@kgi.org.au or Jessica Bennett (Program Coordinator) jbennett@kgi.org.au
 
PARTICIPANT PERSONAL DETAILS
Firstname *
Surname *
Pronouns *
Address *
City *
State *
Postcode *
Phone *
Email *

DOB *
Gender *
Region *


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 *


Why do you want to be involved in this program? *


PARENT/GUARDIAN CONSENT:
I consent to my son/daughter to attend the Richmond Emerging Aboriginal Leadership (REAL) 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.
 *


MEDIA CONSENT
I consent to the Victorian Electoral Commission and KGI including and/or featuring the Applicant’s name and/or image in the form of a photograph or video in any media releases that the Club may publish (in any medium) from time to time.
 *


PRIVACY COLLECTION STATEMENT:
The Richmond Football Club Ltd (Club / us) is committed to protecting the privacy of the personal information we collect. The Korin Gamadji Institute (KGI) is a division of the Club. We will only use the personal information provided in this nomination form for the purpose of: (1) assessing and processing the Applicant’s nomination for the relevant KGI program; (2) communicating with the Nominator, the Applicant and/or the Applicant’s parent/guardian about the KGI program; (3) contacting the Applicant’s parent/guardian and/or emergency contact during the operation of the KGI program if required (Purposes). If the requested information is not provided in the nomination form, this may prevent us from fulfilling our Purposes.
We may disclose the personal information in the nomination form to others for administrative, educational and health related purposes used in the operation of the KGI program. We may also disclose the Applicant’s personal information to a third party to lessen or prevent a serious threat to the Applicant’ safety or welfare, or when required or authorised by law (such as government departments, agencies). From time to time, we may publish media releases about the KGI program (via various channels including our website, social media platforms) or those of our approved partners which may include or feature the name and/or image of the Applicant. We will otherwise not disclose any of the personal information to any third party without the relevant individual’s consent.
Our privacy policy is available at www.richmondfc.com.au/privacy which contains further details about how an individual can access or correct information we hold about them; how they can make a privacy related complaint; and how that complaint will be dealt with.



The Korin Gamadji Institute is a part of the Richmond Football Club and is supported by the Australian Federal Government, Culture is Life and the Victorian Electoral Commission.