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Move and Mingle
Regulation and Rhyme
Parent Workshops and Groups
Bold and Brilliant
Therapy Camps
Adventure Camps
Boys Camps
Camp Confidence
Girls Camps
Regional Outreach
Functional Assessments
Events
Resources
For Teachers and Parents
For Therapists and Students
Therapy Camp Supports
For Police and First Responders
Fees and Rebates
NDIS Funding
Contact
Home
About
Services
Therapy
Occupational Therapy
Speech Pathology
Clinical Psychology
Social Work
Somatic Movement Therapy
Group Therapy Programs
Creative Minds
Winter Warriors
Sense Rugby
Move and Mingle
Regulation and Rhyme
Parent Workshops and Groups
Bold and Brilliant
Therapy Camps
Adventure Camps
Boys Camps
Camp Confidence
Girls Camps
Regional Outreach
Functional Assessments
Events
Resources
For Teachers and Parents
For Therapists and Students
Therapy Camp Supports
For Police and First Responders
Fees and Rebates
NDIS Funding
Contact
Menu
Home
About
Services
Therapy
Occupational Therapy
Speech Pathology
Clinical Psychology
Social Work
Somatic Movement Therapy
Group Therapy Programs
Creative Minds
Winter Warriors
Sense Rugby
Move and Mingle
Regulation and Rhyme
Parent Workshops and Groups
Bold and Brilliant
Therapy Camps
Adventure Camps
Boys Camps
Camp Confidence
Girls Camps
Regional Outreach
Functional Assessments
Events
Resources
For Teachers and Parents
For Therapists and Students
Therapy Camp Supports
For Police and First Responders
Fees and Rebates
NDIS Funding
Contact
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Student Placement Form
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Student Placement Form
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2
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Date form Completed:
*
MM slash DD slash YYYY
Name:
*
University/Institution enrolled in:
Current year level:
What course are you studying:
Occupational Therapy
Social Work
Speech Pathology
Therapy Assistant
Other
Contact Details
Suburb travelling from:
Primary Phone Number:
*
Secondary Phone Number:
Email:
*
Preferred Method of Contact:
Email
Phone Call
Text
Emergency contact details
Name:
*
Relationship to you:
*
Phone Number:
*
Medical information
Do you have any medical conditions, allergies, dietary needs or medications that we need to be aware of?
*
Yes
No
If yes please describe below:
About You
What are your relevant trainings and/or strengths?
Please state the goals that you wish to achieve/learn from placement:
*
Do you have any requests or personal considerations that you require us to consider when it comes to placement tasks and hours?
i.e. do you have after hours comments such as sport/work that prevents you from attending late appointments. Or any medical considerations that restricts from participating in placement activities
We have therapy dogs in training who are sometimes at headquarters or attend camps. Do you have allergies or are you fearful of dogs? Please comment below.
Photo/Video Consent
I hereby give my permission to the staff of Calm and Connected to make photographic, audio, or visual recordings of me while attending Calm and Connected’s Therapy Intensive Programs. Photos/Video of me may be used as indicated below. This consent if valid for 5 years and I understand that I can notify Calm and Connected of change in consent at any time.
To be filmed for training/supervision purposes
*
Yes
No
To be uploaded on Calm and Connected’s social media and or marketing resources
*
Yes
No
Name:
*
Please upload a copy of your Working With Children Check
*
Max. file size: 128 MB.
Please upload a copy of your Police Clearence
*
Max. file size: 128 MB.
Please upload a copy of your NDIS Worker Screening Check
*
Max. file size: 128 MB.
Please upload a copy of your COVID Vaccination Record
*
Max. file size: 128 MB.
First Aid Certificate
*
Max. file size: 128 MB.
Car insurance certificate of currency if you are going to be using your own vehicle on placement
*
Max. file size: 128 MB.
NDIS Worker Orientation Module Certificate
*
Max. file size: 128 MB.
Education Department Police Clearance- if you have one
Max. file size: 128 MB.
Calm and Connected's Confidentiality Agreement - please read carefully
*
Yes I consent and agree
Principles
:
Confidentiality of all client details, records, circumstances and information is to be strictly maintained at all times during fieldwork. Students must agree to abide by these confidentiality requirements when they sign the Calm and Connected Confidentiality Agreement prior to commencing fieldwork.
The following issues related to confidentiality must be considered but are not limited to:
- No documents or copies of documents with identifying information should be taken from the fieldwork facility.
- Students must never read or discuss any information relating to their relatives or friends who may be receiving services from that facility.
- Students must never discuss with clients, information that is not relevant to the current scope of the professional relationship including details about other clients, staff, students or workplace information.
- Students must never talk about clients outside of the fieldwork facility in any way that may allow the client to be identified.
- Students should be mindful in their use of social networking sites (eg Facebook) and public forums not to relay information that may impact on the reputation of fellow students, supervisors, and staff members, Calm and Connected and partner organisations.
- Student forums and discussion groups, workshops and tutorials are considered to be ‘public forums’. If situations or experiences of the fieldwork are to be discussed in these sessions, it is appropriate to avoid identifying information.
- Students must never agree with the client to keep confidential information from their supervisors or other team members, which may affect the professional relationship, therapeutic intervention or other circumstances of the fieldwork.
This Agreement of Confidentiality continues after the fieldwork has been completed.
Calm and Connected's Policies and Guidelines
Calm and Connected maintains the tenets of professional confidentiality and observes the requirements of the Privacy Act. All other relevant policies can be viewed upon request from your supervisor. You will be asked to read all relevant policies and procedures during the term of your placement.
Privacy Policy
According to the Federal Privacy Act 1988, Calm and Connected is required to maintain confidential records according to standard practices. To that end, the Calm and Connected has developed a confidentiality policy, which contains the following key provisions:
Record Keeping
- Each Service maintains records on all clients in keeping with normal standards of professional accountability.
- These records are not accessible to any person outside the particular Service.
Release of Information
- Information about a client may be released to parties outside a Service only with the explicit consent of the client. Release of information will normally require a written consent to disclosure signed by the client. Verbal agreement may be accepted only when both client and staff member agree that the circumstances do not require the formality of a written agreement.
Limits of Confidentiality
Information may be disclosed without the consent of a client when:
- There exists a clear danger to the client or to others
- There exists a legal obligation to do so.
- Legal obligation includes such circumstances as a court subpoena, a valid search warrant, or such other legislated requirements that may be in force at any given time.
Consent
In order to proceed onto the fieldwork, you need to accept the conditions of the Calm and Connected's Confidentiality Agreement. If you have any questions or concerns please contact Kate Keisler at contact@calmandconnected.com.au or speak to your university fieldwork coordinator.
Calm and Connected's Intellectual Property Agreement - please read carefully
*
Yes I consent and agree
Intellectual Property Agreement
:
‘Intellectual Property’ includes all trademarks (registered or unregistered), designs, patents, methods, procedures, manuals, practices, processes, workshops, inventions, modifications and discoveries, content whether written or in any other format.
The following issues related to Intellectual Property must be considered but are not limited to:
All intellectual property of Calm and Connected is and at all time remains the sole property of Calm and Connected. Access to, use or any other entitlement gained to the Student is granted by way of limited licence or permission and no right title or interest in any intellectual property of Calm and Connected shall be vested in the Student.
Any discovery or invention or secret process or improvement in procedure that the Student makes or discovers during the currency of their employment must be disclosed to Calm and Connected and will belong to and be the absolute property of Calm and Connected.
The Student acknowledges and agrees that:
(a) All Intellectual Property created by the Student during their engagement will be owned by Calm and Connected;
(b) Calm and Connected may change, copy, edit, add to, take from, adapt and/or translate a work in any manner or context for any purpose related to Calm and Connected's business, notwithstanding that such conduct may amount to derogatory treatment of the work within the meaning of the Copyright Act 1968 (Cth);
(c) The Student provides Calm and Connected with unconditional and irrevocable consent to all Intellectual Property created in the course of their engagement with Calm and Connected. This consent includes the agreement of the Student to the extent permitted by law;
(i) Not to enforce any claim any of them may have against Calm and Connected arising from the use of the Intellectual Property by Calm and Connected or any third party authorised by Calm and Connected;
(ii) That Calm and Connected need not acknowledge any of their authorship of any Intellectual Property;
(iii) That Calm and Connected may make or authorise any modification, variation or amendment of any nature to the Intellectual Property; and
(iv) That Calm and Connected is given consent to breach any moral rights of any of them in the Intellectual Property;
(d) The Student will do all reasonable further things requested by Calm and Connected to secure its ownership or registration of rights in Intellectual Property created in the course of their engagement, and grant to Calm and Connected the right to use their name to obtain any such protection; and
(e) That the Student will not do anything that might damage Calm and Connected's Intellectual Property rights.
Consent
In order to proceed onto the fieldwork, you need to accept the conditions of the Calm and Connected's Intellectual Property Agreement. If you have any questions or concerns please contact our team at contact@calmandconnected.com.au or speak to your university fieldwork coordinator.
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