Life Choices Program - Booking Form Public

GENERAL INFORMATION

School name

Phone number

Address (please include nearest cross street & entry point if different to school address)

Main Contact / Session Coordinator

(This contact must be available ON THE DAY and when the LCF team arrives)

Name

Position

Mobile/Direct Line

Second Contact

(If applicable or if Main Contact is on class at LCF arrival time)

Name

Position

Mobile/Direct Line

Presentation Information

Date of presentation

Arrival time (1 hour prior to presentation start time)

Presentation start time (Morning session - no later than 10.00 am start time. Afternoon session from 1.00 pm onwards)

WE REQUIRE A MINIMUM OF 60 MINUTES PRESENTATION TIME. All other activities i.e. roll call, students being seated etc, must be in addition to this.

Presentation finish time (60 mins)

Time allocated to view race car after presentation

(Recommend approx. 15/20 mins)

Session/Car viewing time (Start)

Finish

Is the car viewing during class time?

Yes

Is it during a break?

Recess

Lunch

End of day

Replica Race Car display location

(Must be in a high impact area where students congregate e.g. main quadrangle / canteen area)

Please confirm the presentation will be run through the Welfare & Wellbeing Curriculum

Yes

If No, please advise what Department

Please confirm the presentation has been put in the school calendar

Yes

MANDATORY FEEDBACK SURVEYS

Your survey preference

Online Survey Monkey Link

Paper Forms

(Please note surveys are compulsory and form part of this agreement. A fee of $500 may be charged by LCF to schools that receive the program free of charge (sponsored) and do not provide the feedback forms)

Date surveys will be completed

Our mandatory feedback surveys must be completed no later than 48 hours after the presentation. See Principal/DP approval page 3

SCHOOL INFORMATION

Year Group(s) attending

(Minimum 100 students, Year 10 students preferred, however other year groups may be added if required for minimal numbers)

Expected attendance numbers

(Break down into year groups if applicable)

School type

Do students need to have names marked off?

Yes

Time Allocated

mins

PRESENTATION VENUE

Where will the presentation be held? (Must be in an internal room or hall)

Confirm the presentation venue will be available on arrival

Yes

Chairs (Must be provided for students)

Confirm chairs

Tiered seating/Theatre Room set up

STAGE REQUIREMENTS - A SUITABLE STAGE NO MORE THAN 60 CM HIGH MUST BE PROVIDED

Stage - Please confirm ALL details of what option you have

Fixed Stage no higher than 60 cm

Portable Stage (at least 3m x 2m)

Drama Blocks (at least 3m x 2m):

Height of Stage

Or number of drama blocks

Photos of proposed presentation area & stage (Please provide a photo of the area/room you are hosting us in)

Yes

Same venue as last year

AUDIO VISUAL EQUIPMENT & AV CONTACT DETAILS

Life Choices require specific AV and Sound equipment to run the presentation. Please confirm the availability of the following items

Data Projector with HDMI cable (10m required)

Yes

HDMI cable length in metres

Is the VGA/HDMI connection at front of stage?

Yes

If no, where is it run from?

Screen for Projection - Please provide size

Yes

If yes, please provide size

Cordless Microphones x 1

Yes

Sound system / Speakers / Amplification

Yes

Is the sound run from the front i.e. near stage?

Yes

If no, where is it run from?

Audio Visual Contact

(If AV contact is not the Main Contact / Session Co-Ordinator) NB: Please ensure AV contact is available 1 hour prior to presentation to assist with set up

Name

Phone

ADDITIONAL INFORMATION

Social Media Contact

(Must be a contact we can correspond with about promoting our visit via social media)

Name:

Position

Mobile/Direct Line

Do you have any students who may be triggered by certain topics? If so, what topics would they be? Are there any specific issues the school community is currently experiencing that we should be aware of before our visit?

Yes

If yes, please specify

Do you require any other details of the presenter other than their WWCC?

Yes

If yes, please specify

Are you interested in receiving information about our other programs?

Make Bullying History Program (Years 7 – 12)

Is This For Real? Digital Program (Year 6 and 7 only)

BOOKING APPROVAL

Principal/Deputy Principal approving our visit

This approval includes your acknowledgement that our MANDATORY feedback forms will be completed and provided to us within 48 hours of our visit. This is conditional on our attendance and you agree to students and staff completing this task by signing this form.

Name

Position:

Principal

Deputy Principal

Signature

Date

*Important information please read these terms before signing The normal cost of this presentation is $2000 however we have agreed to waiver the fee and to provide it for free as part of the Life Choices Foundation’s commitment to Youth Wellbeing and Health Programs. However, this is conditional on your unconditional commitment to having the staff and students complete the feedback survey forms provided and returning these with 48 hours unless otherwise agreed by us. Failure to do this will result in a $500 fee being payable for the presentation. Further a $500 fee will be payable if the booking is cancelled by you within 7 days of the presentation date. Thank you for your booking. We are looking forward to bringing the Life Choices Program to your school!

Please print, sign and return to manager@lifechoicesfoundation.com.au

Life Choices Program – Booking Request

GENERAL INFORMATION

Main Contact / Session Coordinator

Second Contact

Presentation Information

MANDATORY FEEDBACK SURVEYS

SCHOOL INFORMATION

PRESENTATION VENUE

STAGE REQUIREMENTS - A SUITABLE STAGE NO MORE THAN 60 CM HIGH MUST BE PROVIDED

AUDIO VISUAL EQUIPMENT & AV CONTACT DETAILS

Audio Visual Contact

ADDITIONAL INFORMATION

Social Media Contact

BOOKING APPROVAL

It’s your life. So, make it count.

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