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SkillUp! – Registration Form
SkillUp! – Registration Form
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First Name
*
Last Name
*
Pronouns
How would you like to be referred to during this program? E.g. He/His, She/They
Date of Birth
*
Gender
*
Male
Female
Intersex
Non-Binary
Prefer not to say
Email Address
*
Home Address
*
Are you of Aboriginal or Torres Strait Islander heritage?
*
Yes
No
Prefer not to answer
Has anyone in your family completed a university degree?
*
Yes
No
Does your family speak any language other than English?
*
Yes
No
Are you completing Year 10 in 2025?
*
Yes
No
I am completing High School at
*
Marian Catholic College
Murrumbidgee Regional High School - Griffith Site
Murrumbidgee Regional High School - Wade Site
Verity Christian College
If other, please specify below
Do you have any medical conditions, learning disabilities or other additional needs?
*
Yes
No
If you indicated "Yes" above, please outline details
Known Allergies/Dietary Requirements
Parent/Carer Full Name
*
Parent/Carer's Relationship to the Student
*
Parent/Carer Email Address
*
Parent/Carer Phone Number
*
I (the student) affirm that I have read the Student Agreement, and agree to the Student Agreement/any other relevant documents or policies provided by the CUCWR.
*
Yes
No
Students who do not accept and adhere to the rules provided in the Student Agreement will be removed from the Program.
I (the parent/carer) acknowledge that I have read, understand, and agree to the terms outlined in the document, without limitation. I further understand that my consent, and the provision of my child’s personal information, is necessary for their participation in the CUCWR services.
*
Yes
No
CUCWR will handle all personal information in accordance with our Privacy Policy and ensure compliance with the Privacy Act 1988.
We may have a photographer taking photos of students during the program. I (the parent/carer) give my consent to photographing and video recordings, containing images of my child obtained by Country Universities Centre (CUC) being used by CUCWR free of charge for CUC publications/presentations, in CUC websites/social networking sites, in media including newspaper/magazine/television/radio/film; in research and evaluation.
*
Yes
No
CUCWR will handle all media content in accordance with our Privacy Policy and ensure compliance with the Privacy Act 1988. By agreeing to the above, I understand that images may be published from time to time by CUC and while I can withdraw my consent for the use of the images/videos in further publications at any time, I understand and agree that images that have already been published could be viewed in the future and that CUC may be unable to prevent this from occurring.
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