Rebus  'Acting Out: On Screen' Enrolment Form 2025
Acting Out on Screen is a Short Film Making School Program for people for LGBTQIA+ people aged 12-17 
It will run from Tuesday 28th January 2025 - Monday 31st October 2025.
Location: Woden Library 
Parent/Guardian info

*Important note. These contact details will be used to communicate about the program. If you are over 16 and self enrolling, put your own details here. 

Participant Info 
Participant legal name
Preferred first name
Pronouns
Participant phone number (if applicable)
Participant email (if applicable)
Date of Birth
Would you like to share any worries / concerns / ideas with one of our LGBTQIA+ support workers before the program begins?  >>>> Select 'yes' to book in a chat. 


Medical and Dietary Info
Dietary and allergy information - Is there any dietary or allergy information we should know about? There will be catering provided for lunch and snacks each day. 
Medical info - Does the participant have any medical conditions? ie Asthma, Diabetes, Seizures? How would you like Rebus Tutors to best respond to a condition that may effect things like participant memory / consciousness / breathing during a workshop?
Other accessibility info 
Add information that you feel Rebus Tutors may need to know to ensure that the participant feels comfortable, safe, and heard here:

Some examples of accessibility needs that might help Rebus Tutors prepare their classes: 
  • Movement needs - wheelchair / mobility aids / falls risk
  • Communication support -  low or no vision, deaf or hard of hearing, communication device, sensory processing needs  
  • Cultural safety needs
  • Sensory supports - a need for specific lights, senstivity to smells, use of fidgets
This information will be kept in our enrolment system accessible to Rebus admin staff, and a copy of it will be made available to our Tutors via the roll. Only add what you feel comfortable keeping mind the more information we have, the safer we can make the experience.
Emergency Contact
Who should we call in an emergency if we are unable to contact the primary parent/carer. 

Emergency contact name
Relationship to participant
Emergency contact phone
Transport
We are currently exploring the possibility of offering transport for participants through Capital Region Community Services (gold coin donation per trip) where there is a need. Registration with CRCS, including a signed parental consent form, will be required before transport support can be provided.

Please indicate if you would be interested in this service.  
Photo consent 
Do you give consent for Rebus to use Photo or Video of the participant taking part in our programs?
These would be used to promote current programs and seek funding for future programs.
Tickets: 0 Total: $0 

Pay what you can in tax deductible donations for future programs

While we have raised enough money to fund the program this year, we ask that participant's families make a tax deductible donation so we can ensure the program's continuation. 

Purchase Options Quantity  
(Recommended) - I would like to make a tax deductible donation to cover the cost of one persons attendance of future programs ($399)
I would like to make a tax deductible donation to cover the cost of two people's attendance of future programs ($798)
I would like to make a tax deductible donation to cover half the costs of one persons attendance of future programs ($199)
I would like to make a tax deductible donation to cover some of the costs associated with one person's attendance of future programs ($99)
I am unable to contribute anything at the moment/I would prefer to make a tax deductible donation for an amount of my choosing below

No tickets selected

Would you rather make a tax deductible donation of your choosing to support future programs?
Any donations above $2 are tax deductible
Amount: $0 
Donation amount:
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