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My Support Plan

My Support Plan

My Representative (if applicable)


My Secondary/Emergency Contact (if applicable)


My Likes


My Dislikes


Client Photo


Circumstance


Health


Medical Contact Details


My Emergency & Disaster Management Plan


Consent


My Plan
I will need assistance in the following areas to ensure my safety in the case of an emergency


Other Emergency Phone Numbers
Police, Fire and Ambulance - 000
SES - 132 500


Swimming Profile


To ensure the safety and wellbeing of our clients, swimming activities are always undertaken at a minimum 1:1 support ratio.  


Additional comments


Swimming Waiver 


Declarations & Consents


Consent to Seek Medical Attention


Consent to Administer Medication


Consent for Future Contact


Consent to Share Information


Consent to Take, Store and Share/Publish Photography


I, the participant or representative named above, hereby give my consent for Inclusion Plus to take, display and/or share photographs and/or video of the participant for use in:

* Media releases, media articles – including newspapers, radio, television, printed publications and other organisational marketing materials

* Electronic publications and communications including Inclusion Plus social media platforms and the Inclusion Plus website


I, the participant or representative named above:

* Understand that publication of these images may result in the participant being able to be identified in connection with the images/videos published

* Authorise the use of these images without compensation to me. All prints, digital files and digital reproductions shall remain the property of Inclusion Plus Family Support Inc.

* Understand that this permission will remain valid and effective until written advice has been provided to Inclusion Plus Family Support Inc. withdrawing this authority

* Authorise for group images and group videos of the participant to be shared with other families, if a group photo is taken when attending an Inclusion Plus program


Authorisation

I confirm that all of the above information is true and correct as at the date of signing


Sign Here
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