LGBTIQA+ Social Group 4 Registrations

This group is a free 7-week group primarily for LGBTIQA+ young people aged 16-25 years old who live, work and play in the St George & Sutherland Shire area. We would also like to welcome the wider Sydney LGBTIQA+ community to meet other like- minded young people and contribute to create a safer space where you can explore and express your identity.

When: 6-8pm Thursdays starting on the 12th May 2022

Where: headspace Hurstville centre (dependent on Covid-19 restrictions)

This group will be facilitated in partnership with Twenty10 inc. GLCS. Twenty10 is a Sydney based service that works across NSW, providing a broad range of specialised services for LGBTIQA+ young people including housing, mental health, counselling and social support. Visit twenty10.org.au to learn more!

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* 1. Full name

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* 2. Optional: Preferred name

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* 3. Pronouns

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* 4. Contact number

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* 5. Email address

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* 6. Residential Address

Address

City/Town

State/Province

ZIP/Postal Code

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* 7. Date of birth

Birth Date

Date

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* 8. Age

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* 9. Next of kin - We may need to contact your Next of Kin in case of any emergencies. Please provide the details of your NOK that we can contact.

Name

Relationship to you

Phone number

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* 10. If we had to contact your next of kin, what is the name and pronoun you would like us to use to refer to you, when speaking with them?

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* 11. Do you have any allergies or dietary requirements?

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* 12. Do you have any accessibility issues or needs?
Things to consider include; Travel and mobility needs, do you have any needs around noise levels?

Yes

If Yes please specify:

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* 13. We sometimes discuss things which some people may find uncomfortable or triggering to talk about (i.e. suicide prevention, self-harm etc.).

To best prepare for these situations, are there any topics that may be a trigger for you? If yes, please specify.

If you would prefer to have a phone call chat to discuss this, please state this in your answer.

yes (please specify)

LGBTIQA+ Social Group 4 Registrations

Question Title

* 1. Full name

Question Title

* 2. Optional: Preferred name

Question Title

* 3. Pronouns

Question Title

* 4. Contact number

Question Title

* 5. Email address

Question Title

* 6. Residential Address

Question Title

* 7. Date of birth

Question Title

* 8. Age

Question Title

* 9. Next of kin - We may need to contact your Next of Kin in case of any emergencies. Please provide the details of your NOK that we can contact.

Question Title

* 10. If we had to contact your next of kin, what is the name and pronoun you would like us to use to refer to you, when speaking with them?

Question Title

* 11. Do you have any allergies or dietary requirements?

Question Title

* 12. Do you have any accessibility issues or needs?
Things to consider include; Travel and mobility needs, do you have any needs around noise levels?

Question Title

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* 14. Do you have any concerns or questions about joining this group? If so please share below:

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* 15. Is there anything else you'd like to tell us?

LGBTIQA+ Social Group 4 Registrations

Question Title

* 1. Full name

Question Title

* 2. Optional: Preferred name

Question Title

* 3. Pronouns

Question Title

* 4. Contact number

Question Title

* 5. Email address

Question Title

* 6. Residential Address

Question Title

* 7. Date of birth

Question Title

* 8. Age

Question Title

* 9. Next of kin - We may need to contact your Next of Kin in case of any emergencies. Please provide the details of your NOK that we can contact.

Question Title

* 10. If we had to contact your next of kin, what is the name and pronoun you would like us to use to refer to you, when speaking with them?

Question Title

* 11. Do you have any allergies or dietary requirements?

Question Title

* 12. Do you have any accessibility issues or needs? Things to consider include; Travel and mobility needs, do you have any needs around noise levels?

Question Title

Question Title

* 14. Do you have any concerns or questions about joining this group? If so please share below:

Question Title

* 15. Is there anything else you'd like to tell us?

* 12. Do you have any accessibility issues or needs?
Things to consider include; Travel and mobility needs, do you have any needs around noise levels?