APPLY NOW - 2022 DIGITAL DETOX PROGRAM

Digital Detox Program (DDP) 2022 Applications

We're excited to have you apply for our pilot DDP in 2022. By completing this survey, your application will be submitted into consideration for our program scheduled for 8th-16th January 2022.

Once you have completed this application, you will be contacted by the Youth Services Manager to organise an interview with yourself and your parent/guardian.

The successful participants for the Digital Detox Program will be announced on the 17th December, 2021.

To be eligible to apply, applicants must aged between 12 and 14 on the 8th January 2022.

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Are you ready for the experience of a lifetime?

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* 1. First Name

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* 2. Last Name

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* 3. Address

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* 4. Suburb/Town

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* 5. State

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* 6. Postcode

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* 7. Date of Birth

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* 8. Email

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* 9. Home Phone

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* 10. Mobile

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* 11. How may hours of screen time do you average per day:

Less than 1 hour

1-3 hours

3-5 hours

5-7 hours

more than 7 hours

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* 12. How many hours are you on devices for education purposes? And how many hours are for social or gaming interaction?

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* 13. How would you rate your relationship with technology?

Very unbalanced

Unbalanced

Healthy enough

Balanced with other aspects in life

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* 14. Please tell us a bit about yourself:

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* 15. What school will you attend in 2022? And what grade will you be in?

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* 16. What do you know about the Digital Detox Program?

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* 17. What do you hope to achieve by participating in the Digital Detox program?

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* 18. What would be you biggest concern about disconnecting from technology?

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* 19. Who do you feel will support your involvement in the program? (please specify family member who will attend for for the last 2 days and also who will support you post program)

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* 20. Do you identify with being Aboriginal or Torres Strait Islander?

Yes

Not sure

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* 21. Do you have any known medical or health conditions?

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* 22. Have you had any past injuries/operations?

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* 23. Where did you hear about the program?

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* 24. I understand that the Digital Detox program is a 9 day camp at which I will not have access to devices/technology including my mobile phone and earphones.

Agree

Disagree

PARENT/GUARDIAN INFORMATION

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* 25. Parent/Guardian First Name

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* 26. Parent/Guardian Second Name

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* 27. Parent/Guardian Email

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* 28. Parent/Guardian Home Phone

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* 29. Parent/Guardian Mobile

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* 30. I understand that the Digital Detox program is a 9 day camp at which my child will not have access to devices/technology including their mobile phone and that a parent/guardian must attend the final 2 days of the camp.

Agree

Disagree