7023_AllambiCare_Spicy-Brain_Social-Landscape_V1.1

Applications are officially closed

*Please contact Tamara Tranby to discuss if there are opportunities still available for participation.*

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Thanks for your interest in the 2025 Spicy Brain event!

The survey will take approximately 6 minutes to complete. All sections of this form must be completed to ensure the CYP / Participant details are accurately captured. This form will provide information to the Spicy Brain committee of the CYP / Participants wishes to be involved in the Spicy Brain creative arts event.

Carer/Support Worker details

Name of person completing form*

Relationship to young person / participant*

Mobile phone number*

Email*

Young person/Participant details

First name*

Last name*

Date of birth*

Does the young person identify as Aboriginal and/or Torres Strait Islander?*

Is the young person/participant Culturally Linguistically diverse?*

Please provide a brief description of their diagnosis. (E.g. Sensory Processing Disorders, Physical Disability, ASD, ADHD, Intellectual Disability, FASD etc).*

What is the young person/participants' developmental age?*

Please indicate program area*

Does the young person/participant require guardian approval to participate?*

If you answered YES to the above question please indicate who the name and title of the person who will be approving the young person/participants participation.

Management Details - House Manager / Caseworker / Casework Manager

Management Details - Case Manager / Therapeutic Specialist / Manager

Participant's creative super-power

Description of the young persons/participant's creative arts that they wish to have on display/perform*

If you chose a performance above, what would be the estimated duration?

Would the young person/participant like to sell their art piece/design items during the Spicy Brain event?*

Would the young person/participant like to do a duet/music piece with Nathan Trimble to your favourite pop song? (limited positions)*

Would the young person/participant and carer/Support Worker like to be involved in the Spicy Brain Photography Exhibition?*

Would the young person/participant or anyone else from the team wish to be a volunteer on the night of the event? Please provide a detailed list of names and contact details (preferably phone details).*

*Applications are officially closed*

Carer/Support Worker details

Young person/Participant details

Participant's creative super-power

Applications are officially closed