Membership Form

Main Content

To apply for the Program you can either:

  1. Complete the application forms online form. It takes approximately 20 minutes. There are five forms to complete, parents/ carers need to complete the 4 sections included within the “Family Form” below, and also the separate “Sponsor Form”.
  2. Or, download the word doc form and submit via our email to admin@tirkandi.org.au (you’ll also need to download and send the separate “Sponsor Form”.

Please make sure you complete all 5 forms as outlined above.

Once we’ve reviewed your details, we’ll contact you within 7 days to discuss your application further.

 

Family form: Membership Details

Member details form

Member Details

Contact numbers

I agree to be bound by the rules of the association and apply to be a member of the above named incorporated association. *
I am a member of the association and nominate the applicant who is personally known to me, for membership to the association. *

Personal profile and experience:

Family form: Parent / Legal Guardian Consent

Family form: Consent Form

Parental/ Legal Guardian Consent

I give permission for my son/ the applicant to:

  • attend the Tirkandi Inaburra program on a “voluntary basis” for the entire 10-week program

  • participate in all aspects of the program including educational, cultural, sporting, life and living skills activities, and vocational training if applicable, and any other research and evaluation activities

  • receive medication administered by Tirkandi Inaburra as prescribed and instructed by a medical practitioner (Tirkandi will seek additional authority for any changes to medication for young persons under the care of the Minister)

  • receive all forms of medical attention and treatments as required

  • receive all required treatments in the case of an emergency (Tirkandi will seek additional authority for medical surgery and/ or treatment for young persons in the care of the Minister)

  • Tirkandi Inaburra receiving, retaining and where necessary acting on personal information about my son/ the young person

  • Tirkandi Inaburra monitoring my son’s progression post-graduation from Tirkandi Inaburra for a period of no less than 3 months and obtaining relevant data for research and evaluation purposes

  • The use of my son’s image (via photographs and video) by Tirkandi Inaburra for material used to promote the work of Tirkandi Inaburra and any work related to the day-to-day functioning of Tirkandi Inaburra

  • Allow Tirkandi Inaburra to carry out a Criminal History check for the safety and wellbeing of other participants and staff. Providing and requesting information under Chapter 16A

  • Allow services linked with Tirkandi Inaburra to provide after care for my son and my family following the young person’s exit from the program

  • Tirkandi Inaburra collecting and storing information

    • I agree to the above statement: *

    Family form: Parent / Legal Guardian Details

    Family form: Parent/ Legal Guardian Form

    Parent/ Legal Guardian Details #1

    Parent/ Legal Guardian Details #2

    Living Arrangements

    Is the applicant/ young person living in out of home care?

    Applicant (Young person) information

    Does your son/ the applicant currently, or has he ever:

    Transport Arrangements

    Exit Procedures

    Exit procedures are required in case your son/ the applicant wishes to leave the program, is removed or must leave due to an emergency. Tirkandi Inaburra Cultural & Development Centre must be able to execute this exit procedure 24 hours per day, seven days per week.

    In the case that my son/ the applicant wishes to leave the Tirkandi Inaburra Program, is removed or must leave due to an emergency:

    I give Tirkandi Inaburra permission to undertake the following exit plan: *

    Parent/ Legal Guardian Signature

    I have been informed about the aims of the program and the range of activities undertaken at the Tirkandi Inaburra Cultural & Development Centre.

    I am aware that my son/ the young person will attend the Centre on a voluntary basis and may leave at any time.

    I understand that Tirkandi Inaburra will assume full responsibility for my son/ the young person while he is in the program and thus, and only as required, may need to consent as the temporary guardian of my son to his attendance on school excursions and receive any forms of medical attention and treatments as required.

    I will resume full responsibility for my son when he leaves the Tirkandi Inaburra Cultural & Development Centre program, when on home leave, on exiting the program or if suspended from the program.

    I agree to the above statement: *

    Family form: Consent to Carry Out a Criminal History Check

    Family form: Consent to Carry Out Criminal History Check

    I give the Centre Manager of Tirkandi Inaburra consent to carry out a Criminal History Check on my son.

    As per the eligibility criteria, if any applicant has been charged and convicted of any offence/s this needs to be declared to the Centre Manager prior to the participant’s acceptance. If a participant has been charged and convicted of an offence the Centre Manager will make further enquiries into certain aspects of the incident;

    • Seriousness of the offence
    • If the offence involved acts of violence
    • If the offence involved co-offenders

    After this information has been sought a decision will be made as to the suitability of the applicant by the Management committee.

    If this applicant has committed an offence and has been dealt with under the Young Offenders Act by way of;

    • Warning
    • Caution
    • Conference

    The applicant may still be suitable, but this information needs to be declared to the Centre manager or his delegate.

    I agree to the above statement: *

    I declare that he/she has/has not been charged and convicted of any Criminal Offence/s? If so what was the offence, outcome and when did this occur?

    I agree to the above statement: *

    I declare that he/she has/has not committed any offence/s which has been dealt with under the Young Offenders Act? If so what was the offence, outcome and when did this occur?

    I agree to the above statement: *