GUB's Girls who bALL Program
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This is an expression of interest form the weekly Girls who bALL program running at AWA Stadium on Wednesdays from 4pm-5pm on August 14, 21, 28 and September 4th 2024.
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Email *
Participants name *
Parent or guardians name *
Parent/guardian phone number
 *
Do you require an interpreter or assistance to complete this form?
 *
Participants date of birth (DOB)
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DD
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Gender (the gender with which the participant identifies)
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Address *
Who is completing this form? *
Does the participant identify as Autistic or a person with Autism or someone with characteristics associated with Autism? (can be diagnosed or undiagnosed)
 *
Does the participant identify as a person with disability? (can be diagnosed or undiagnosed) *
Next we will ask you some personal information to better understand how we can best assist you to participate in and enjoy basketball.
You can answer or not answer any question you like. You can give us as much or as little information as you like. All information received will be confidential and used to support you to achieve your goals.
Your individual support needs?
Tell us the about the support you usually require to engage in everyday activities? eg wheelchair, support person, sensory items, etc
Basketball experience/confidence/physical activity levels?
Do you play basketball or any other sports regularly? Do you have the capacity to run? Are you physically active?
Behaviours we should be aware of, triggers and behaviour support strategies?
Medical condition or allergies?
Your expressive and receptive language abilities?
Do you communicate verbally or using an ipad or PECS etc?
Special interests, favourite items, activities, likes, dislikes, phobias?
Is your parent, carer or support person available to attend the program with you and assist you to participate in on field activities?
We would like to know what support will be available to each participant.
Geelong United Basketball Media Consent

I hereby consent and agree that GUB has the right to take and use photographs and videos of me, including online, for purposes including internal use and external promotional and marketing material.

I hereby release to GUB all rights to exhibit this work in print and electronic form publicly or privately and to market copies. I waive any rights, claims or interest I may have to control the use of my identity or likeness in the photographs taken by GUB and agree that any uses described may be made without compensation or additional consideration of me. We will not use any photos without permission from the participant (if over 18 years) or the parent/ caregiver (if under 18 years)
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Participation Consent and Consent to Share Information

As a participant in a GUB program, we need your consent to work with you. In order for us to provide you with the best support we can, we may need to record information about you, including your name, date of birth, ethnicity, visa, disability needs and so on. We do not share this information with any other organisations without your consent, and all information is kept in a secure file. To be able to support you in this program, we need your consent to share your information in order to communicate and register with relevant sporting and recreational clubs and organisations.

From time to time we are required to provide reports to our funding bodies on the progress of the program. We will use some of your information in these reports, but never in a way in which you can be personally identified.

The only time we will ever share your information with another organisation is if we have serious concern for your safety, or the safety of others. The kinds of people we would share information with in this instance would be ambulance, fire and police services.

You have the right to complain about the service you receive from GUB and we welcome all feedback. To make a complaint or provide feedback please contact the program at admin@geelongunitedbasketball.com.au *
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