Student Name *

First Name

Last Name

Parent/Guardian Name:

First Name

Last Name

Emergency Contact Details (if different from parent/guardian):

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student Support Needs

Does your child have any diagnosed conditions we should be aware of?

Autism Spectrum Disorder

ADHD

Anxiety

Depression

Learning difficulties

Intellectual disability

Other

WORKSHOP GOALS What are your main concerns about your child's transition to high school? (Select all that apply)

Making new friends

Fitting in with peer groups

Starting conversations

Handling social conflicts

Building confidence

Managing social anxiety

Understanding social cues

Handling bullying

Handling rumours and gossip

Other

Program Evaluation

Program Evaluation:

I consent to my child participating in brief feedback surveys to help improve the program

I consent to being contacted for follow-up feedback 3 months after the workshop

ACKNOWLEDGMENTS

Please confirm you understand: *

This workshop is FREE thanks to Knox Council's Minor Grant Program

The workshop is limited to 20 students and places are allocated on a first-come, first-served basis

I will receive a confirmation email with workshop details within 48 hours

I understand I can contact Strivesocial with any questions on 0408 707 866

Our family holds a current Healthcare Card (priority placement)

Communication:

I would like to receive information about future Strivesocial programs

I would like to receive Strivesocial's newsletter with social skills tips and resources

TERMS AND CONDITIONS *

By submitting this registration, I acknowledge that:

All information provided is accurate to the best of my knowledge

I give permission for my child to participate in the workshop activities

I will notify Strivesocial of any changes to contact details or support needs

I understand that Strivesocial staff are mandatory reporters