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New Page
ICPHR ‘Kids in Action’ Initiative – Registration
Welcome to the registration page for the
Kids in Action
initiative!
Data Protection Statement:
ICPHR uses your personal information in line with the University of Melbourne’s Privacy Policy which complies with the Privacy and Data Protection Act 2014 (Vic); Health Records Act 2001 (Vic); Public Records Act 1973 (Vic); and the Privacy Act 1988 (Cth)
Project Information
*
Indicates required field
1. What is the name of the project? (this can be changed later if needed):
*
2. Where is the project being conducted?
2(a) City/Town
*
2(b) Country
*
3. Please describe the project (max 400 words):
*
4(a) Who is leading this project? (tick all that apply)
*
Children (14 years and under)
Youth (15-25years)
Parents
Teachers
Researchers
Health workers
Community workers
Volunteer
Other
4(b) If other, please specify:
*
5(a) Who makes the decisions for this project? (tick all that apply)
*
Children (5 years and under)
Children (6-9years)
Children (10-14years)
Youth (15-25 years)
Parents
Teachers
Researchers
Health workers
Community workers
Other
5(b) If other, please specify:
*
Contact information
6(a) Name
*
First
Last
[object Object]
6(b) Email
*
6(c) Skype name (optional)
*
6(d) Gender
*
Female
Male
Other
6(e) Age
*
14 years or under
15-25 years
26+ years
6(f) If you are under 18 years of age, please provide the email contact of a parent/guardian/teacher who can confirm it is okay for you to provide your contact details as part of this registration:
*
7. Would you like to be linked to other projects addressing the same topic?
*
Yes
No
8(a) Start date of project (mm/yy)
*
8(b) End date of project (mm/yy)
*
9(a) Please indicate your preferred language for communication as there may be future opportunities to have resources in different languages (please select below):
*
English
Arabic
Bengali
French
German
Hindi/Urdu
Italian
Japanese
Mandarin
Portuguese
Punjabi
Russian
Spanish
Swedish
Other
9(b) If 'other' language, please indicate in the box below:
*
Thank you so much for your interest in Kids in Action! We will be in touch within 2 weeks to let you know what comes next.
Additional details including useful resources and references relating to PHR with children are available on the
ICPHR website
.
For further information contact:
Associate Professor Lisa Gibbs, Director of the Jack Brockhoff Child Health and Wellbeing Program, and Co-Chair of the Improving Children’s Lives Initiative, University of Melbourne, Australia -
lgibbs@unimelb.edu.au
Submit
