KGI - REAL EMPOWERED PROGRAM APPLICANT FORM
 
 
About the REAL Empowered Program
REAL Empowered is aimed at KGI alumni aged 16-18 years old. This program will focus on Culture & Connection and Growth & Wellbeing whilst strengthening employment skills and education and career pathways. Participants will gain value from opportunities presented by our program partners in the employment and education sectors.

Program will commence in April on Sunday 14th and finish Thursday 18th

This program is all-inclusive and costs are covered by KGI.

Any questions regarding the program please contact Thara Brown (Program Manager) tbrown@kgi.org.au or Tahlia Biggs (Program Coordinator) tbiggs@kgi.org.au
 
PARTICIPANT PERSONAL DETAILS
Firstname *
Surname *
Address *
City *
State *
Postcode *
Phone *
Email *

DOB *
Gender *


PARENT/GUARDIAN DETAILS
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. Why do you want to complete the KGI REAL Empowered program? *
2. How have you demonstrated leadership in your school or community? (List any awards or achievements that you are proud of)  *
3. What qualities do you believe you possess that make you a good leader? *
4. What areas would you like to strengthen or improve in the personal and professional development (What are you hoping to get out of this program)? *
5. What are the main learnings that you have gained from your involvement with KGI? *
6. What are your ambitions for the future? *


COMMITMENT TO THE PROGRAM
I understand that successful registration into the REAL Empowered Program means a commitment to the following dates:

  1. Friday 15th to Sunday the 17th of June
  2. Friday the 20th to Sunday the 22nd of July
  3. Friday the 17th to Sunday the 19th of August


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.
 *