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    • East Kimberley Clinic
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      • Therapy Camp Supports
    • For Police and First Responders
  • Fees and Rebates
    • NDIS Funding
  • Contact
  • Home
  • About
  • Services
    • Therapy
      • Occupational Therapy
      • Speech Pathology
      • Clinical Psychology
      • Somatic Movement Therapy
    • Group Therapy Programs
      • Creative Minds
      • Sense Rugby
      • Move and Mingle
      • Pre Kindy Group
      • Parent Workshops and Groups
    • Therapy Camps
      • Adventure Camps
      • Boys Camps
      • Camp Confidence
      • Girls Camps
    • East Kimberley Clinic
    • 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
      • Somatic Movement Therapy
    • Group Therapy Programs
      • Creative Minds
      • Sense Rugby
      • Move and Mingle
      • Pre Kindy Group
      • Parent Workshops and Groups
    • Therapy Camps
      • Adventure Camps
      • Boys Camps
      • Camp Confidence
      • Girls Camps
    • East Kimberley Clinic
    • 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

Student Placement Form

Student Placement Form

Step 1 of 2

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  • MM slash DD slash YYYY
  • Contact Details

  • Emergency contact details

  • Medical information

  • About You

  • 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
  • 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.
  • Max. file size: 128 MB.
  • Max. file size: 128 MB.
  • Max. file size: 128 MB.
  • Max. file size: 128 MB.
  • Max. file size: 128 MB.
  • Max. file size: 128 MB.
  • Max. file size: 128 MB.
  • Max. file size: 128 MB.
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    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.
    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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Many children have difficulty with everyday skills such as listening, sitting still, staying focused, or joining in with others.

The  Therapists at Calm and Connected provide mobile, clinic & online support to the adults surrounding a child and teach the child how to address the foundational skills that affect our ability to connect.

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