Play Experience Linked Contacts Form

This number doesn't have to be a mobile phone number

Street Address

Street Address Line 2

Suburb

Post Code

MaleFemaleIntersex or IntermediatePrefer not to say

YesNoPrefer not to say

Additional Parent / Carer Details

Street Address

Street Address Line 2

Suburb

Post Code

MaleFemaleIntersex or IntermediatePrefer not to say

YesNoPrefer not to say

MaleFemaleIntersex or IntermediatePrefer not to say

YesNoPrefer not to say

Street Address

Street Address Line 2

Suburb

Post Code

MaleFemaleIntersex or IntermediatePrefer not to say

YesNoPrefer not to say

Street Address

Street Address Line 2

Suburb

Post Code

MaleFemaleIntersex or IntermediatePrefer not to say

YesNoPrefer not to say

Street Address

Street Address Line 2

Suburb

Post Code

Restricted persons

A restricted person is a person who either:

Has been issued a negative notice
- A negative notice remains current until it is cancelled. You can apply to cancel your negative notice 2 years after the date it was issued.
Has a suspended blue card
Is a disqualified person
- convicted of a disqualifying offence
- a reportable offender under the Child Protection (Offender Reporting and Offender Prohibition Order) Act 2004
- the subject of an offender prohibition order under the Child Protection (Offender Prohibition Order) Act 2008
- prohibited by a court from applying for or holding a blue card
- or the subject of a sexual offender order under the Dangerous Prisoners (Sexual Offenders) Act 2003.
Has been charged with a disqualifying offence that has not been finalised.
All disqualifying offences are listed in the Working with Children (Risk Management and Screening) Act 2000.
An offence is categorised as a disqualifying offence under the Act if it is an offence:
- against a provision of an Act detailed in the list of disqualifying offences
- under a law of another jurisdiction that, if it had been committed in Queensland, would have constituted an offence of a kind detailed in the list of disqualifying offences
- of counselling or procuring the commission of an offence of a kind mentioned in the list of disqualifying offences
- of attempting, or of conspiring, to commit an offence of a kind detailed in the list of disqualifying offences
- that has, as an element, an intention to commit an offence of a kind mentioned in the list of disqualifying offences
- or that, at the time it was committed, was an offence of a kind mentioned in the list of disqualifying offences.

Personal information collected on this form will be used by Play Matters Australia as it relates. directly to the programs and services we provide to you and it is required by law. Your personal information will be handled in accordance with The Privacy Act 1988 (Cth), Australian Privacy Principles. Our Privacy Policy is available at playmatters.org.au For information about our Privacy Policy please contact us by email info@playmatters.org.au or telephone 1800 007529.

(New) Play Matters Play Experience Linked Contacts Form

If you will be facilitating the play experience yourself, please select "Facilitator (paid affiliation)", not "Principal (paid affiliation)"

Note: If you are registered under one of our Organisational play experiences, feel free to use the organisations details instead of your own personal information.