Virtual Reality Program in Creswick- EOI

Expression of Interest to participate in VR program

Central Highlands Rural Health (CHRH) is running a three week Virtual Reality (VR) program for young people who live in the Creswick area and are aged 12 to 14 years!

The program aims to enhance physical activity using games that require movement. VR technology requires participants to put a ski-like mask over their eyes to view and enter a virtual world in which they can take part in a range of fun and interactive video games and/or activities.

The program will run over three weeks on a Monday afternoon and will be coordinated by a CHRH Health Promotion Officer and Social Worker. All employees hold a current Working with Children’s Check.

Please see program details below:

Program Dates: 26th April, 3rd May & 10th May
Time: 4:30 - 5.30pm. Snack provided

Location: Creswick Town Hall
Cost: Free of charge

*Parental permission is required

Spaces are strictly limited so if your child would like to express their interest in participating in this three week program, please complete the following questions:

*The following information provided is collected in line with CHRH Privacy Policy.

Note: If you have any questions please do not hesitate to contact Belinda Buck, Manager Population Health belinda.buck@chrh.org.au

This Expression of Interest should only take approximately 3 minutes to complete and must be completed to consider your application to participate in the VR program.

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* 1. Participants full name

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* 2. Participants date of birth

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* 3. Participants gender

Male

Female

Intersex

Non binary

Other (please specify)

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* 4. Is the participant of Aboriginal or Torres Strait Islander (TSI) origin?

Yes- Aboriginal

Yes-Torres Strait Islander

Yes- Both Aboriginal and Torres Strait Islander

Prefer not to say

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* 5. Country of birth

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* 6. Language spoken at home

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* 7. Participant email address (if applicable)

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* 8. What School does the participant attend (if applicable)

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* 9. Primary parent/carer contact details

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 10. If the participant was successfully chosen to be on the program would they be able to attend all three sessions?

Yes

Other (please specify)

Thank you for completing this Expression of Interest. A staff member at CHRH will be in contact with you shortly to advise if you were successful in your application to participate in the program.