Down Syndrome Queensland Membership

Down Syndrome Queensland membership is open to anyone who is living with Down syndrome or has a connection to someone living with Down syndrome. This could be a parent/carer, sibling, grandparent, aunt, uncle, school or organisation. Becoming a member means that you join our community of like minded people who believe in a better life for a person with Down syndrome. A community that is committed to working with government, advocating in all areas and providing information and support to families walking the journey. Becoming a member makes you feel as if you are not alone, you are part of a broader network working to make a difference.

     

 

Details about the individual with Down syndrome

Full Name*
Home Address*
 
City*
State*
Postcode*
 
Email address of individual with Down syndrome (if applicable)
Phone Number of individual with Down syndrome (if applicable)
Date of Birth*
 
Sex of individual with Down syndrome?*
 
Individual with Down syndrome lives with*
 
If other please specify here
 
Does the individual with Down syndrome identify as:
If other please specify here
 
Preferred language (if other than English)
 
Is an interpreter required (please tick if yes)
 
School currently attending (if applicable)
Current workplace (if applicable)
 

Parent / Caregiver / Legal Guardian Contact information - 1

 
Name of Parent/Caregiver
Profession of Parent/Caregiver
 
Address (if different to individual with Down syndrome above)
 
City/town
State
Postcode
 
Relationship to individual with Down syndrome
 
Email Address
Phone number
 

Parent / Caregiver / Legal Guardian Contact information - 2

 
Name of Parent/Caregiver
Profession of Parent/Caregiver
 
Address (if different to individual with Down syndrome above)
 
City/town
State
Postcode
 
Relationship to individual with Down syndrome
 
Email Address
Phone number
 

Person completing form

 
Name of Person completing the form*
 
Relationship to individual with Down syndrome*
 
Email address of Person completing the form*
 

Declaration

 
I have the legal authority to complete this form as the individual with Down syndrome or as a person who is authorised to act on their behalf. All information is true and correct.*
 
Please add the email addresses outlined above to the Down Syndrome Queensland mailing list
 
Please read the Media Release Policy and select an answer from below *
 






Personal information collected on this form will be retained and used for the purpose of processing and delivering Down Syndrome Queensland membership applications for services, programs and normal business practices. It may also be used for other purposes including keeping you informed about the organisation’s activities, events, member networks, distributing publications and providing you with information about things we think may be of interest to you. Without this information we may be unable to provide the member services and programs as intended. De-identified personal and health information may be used for research and statistical purposes for planning services by the organisation or distributed to third parties, such as government agencies or other agencies with an interest in the research. Be assured that this type of data is always de-identified. Personal information will not be disclosed to third parties without consent or in accordance with the law. We take steps to protect all personal, sensitive and health information held against misuse, interference, loss, unauthorised access, modification and disclosure. Credit card details are not stored. You can access the personal information that we hold about you, and you can ask us to correct the personal information we hold about you. If you are listed on one or more of our network email lists you can opt out at any time. You can unsubscribe by using the ‘unsubscribe’ options noted in our emails.

How to contact us

Individuals can obtain further information or provide any comments in relation to this privacy notice, by contacting Down Syndrome Queensland:

Website – Contact us

Address - 282 Stafford Road, STAFFORD, QLD 4053. PO BOX 3223 STAFFORD DC QLD 4053.

Ph: 07 3356 6655; [email protected]

Organisation Information

 
Full name
Organisation (if applicable)
 
 
If other, please specify
 
Address
 
City/town
State
Postcode
 
Email Address *
Phone number
 
Website Address
 
If school, what is the name of the Head of Special Education or equivalent?
 
Email address of Head of Special Education or equivalent
 
Number of people with Down syndrome involved with your organisation
 

Declaration

 
I have the legal authority to complete this form on behalf of the organisation. All information is true and correct.*
 
Please add the email addresses outlined above to the Down Syndrome Queensland mailing list
 






Personal information collected on this form will be retained and used for the purpose of processing and delivering Down Syndrome Queensland membership applications for services, programs and normal business practices. It may also be used for other purposes including keeping you informed about the organisation’s activities, events, member networks, distributing publications and providing you with information about things we think may be of interest to you. Without this information we may be unable to provide the member services and programs as intended. De-identified personal and health information may be used for research and statistical purposes for planning services by the organisation or distributed to third parties, such as government agencies or other agencies with an interest in the research. Be assured that this type of data is always de-identified. Personal information will not be disclosed to third parties without consent or in accordance with the law. We take steps to protect all personal, sensitive and health information held against misuse, interference, loss, unauthorised access, modification and disclosure. Credit card details are not stored. You can access the personal information that we hold about you, and you can ask us to correct the personal information we hold about you. If you are listed on one or more of our network email lists you can opt out at any time. You can unsubscribe by using the ‘unsubscribe’ options noted in our emails.

How to contact us

Individuals can obtain further information or provide any comments in relation to this privacy notice, by contacting Down Syndrome Queensland:

Website – Contact us

Address - 282 Stafford Road, STAFFORD, QLD 4053. PO BOX 3223 STAFFORD DC QLD 4053.

Ph: 07 3356 6655; [email protected]

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