Registration Form

To participate in Arabic Welfare (AW) program(s) and/or receive our service(s), we require you to provide certain information and provide your consent to the below criterion. The information provided will be securely stored and used solely for the purposes outlined in our Privacy Statement.

You have the right to withdraw your information and can request a copy of our Privacy Statement at any time by contacting us at info@arabicwelfare.org.au.

Registration Form

Name(Required)

First Last

Address(Required)

Street Address Suburb State Postal Code Country

Country of Birth(Required)

Ethnic Background(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Phone(Required)

Gender(Required)

Male

Female

Other

Date of Arrival to Australia

MM slash DD slash YYYY

Visa Type(Required)

Language Spoken at Home

Second Language

Medical Conditions

Emergency Contact

Name

Phone

Relationship

I consent to the collection and use of my personal information, including but not limited to my name, address, contact details, and any other information provided in this form, for the purposes of program administration, communication, and/or record-keeping. I understand that my personal information will be handled in accordance with Arabic Welfare’s Privacy Statement.

Consent for Collection and Use of Personal Information

I consent to the sharing of relevant information from my participation in this program with appropriate services as deemed necessary by the program staff for my well-being and/or to address any identified needs. I understand that this information will be shared only to the extent necessary to provide appropriate support and services including but not limited to medical, social, wellbeing, legal, education and/or other services.

Consent Appropriate with Information with Appropriate Services

I hereby grant Arabic Welfare Inc. the right to use quote(s), recording(s), photograph(s), and/ or video(s) taken during the course of my participation in the program/service for all general purposes in relation Arabic Welfare's work including, without limitation, the right to use them in any publicity material, social media, books, newspapers, reports, website and magazine articles whenever Arabic Welfare choose to do so. If I have any concerns, I can contact the Program/ Service Coordinator.

Consent for Use of Image and Voice in Photographs and Videos

I understand and acknowledge that there are inherent risks associated with participating in program and/or receiving service(s). I understand that these risks may include, but are not limited to physical injury, property damage, or medical emergencies. I hereby release Arabic Welfare and its employees, volunteers, and agents from any and all liability for any injuries or damages that may occur to me during the program or while receiving service(s), unless caused by their negligence.

Release of Liability for Participation in Program/Service

I hereby confirm that I have disclosed to the relevant program facilitator(s) and partner(s) all medical conditions that may impact my ability to fully participate in the program/ service. I understand that it is my responsibility to promptly notify them of any changes to my medical condition that may affect my participation during the program and/or service's duration.

Medical Condition Disclosure and Ongoing Notification

I have read and understood the above information and consent to the terms outlined. I understand that I can withdraw my information and consent at any time by emailing info@arabicwelfare.org.au.(Required)

Final Consent

I have read and understood the above information and consent to the terms outlined. I understand that I can withdraw my information and consent at any time by emailing info@arabicwelfare.org.au.

Registration Form

Registration Form

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