Individual / Family Membership

Use this form to become a member if you are an individual with Down syndrome or the Parent/Caregiver/Guardian of an individual with Down syndrome.

If you want to become a member but are not an individual with Down syndrome or the Parent/Caregiver/Guardian of an individual with Down syndrome, please use the Organisation / Other Membership form.

Information on Individual with Down Syndrome
Name of individual with Down syndrome *
Name of individual with Down syndrome
Date of Birth of Individual with Down syndrome
Date of Birth of Individual with Down syndrome
Address of individual with Down syndrome
Address of individual with Down syndrome
Phone of individual with Down syndrome (if applicable)
Phone of individual with Down syndrome (if applicable)
Is an interpreter required (tick if yes)
Parent / Caregiver / Legal Guardian - 1
Name of Parent/Carergiver/Legal Guardian
Name of Parent/Carergiver/Legal Guardian
Address (if different to individual with Down Syndrome
Address (if different to individual with Down Syndrome
Phone of parent/caregiver/legal guardian
Phone of parent/caregiver/legal guardian
Parent / Caregiver / Legal Guardian - 2
Name of Parent/Caregiver/Legal Guardian
Name of Parent/Caregiver/Legal Guardian
Address (if different to individual with Down syndrome
Address (if different to individual with Down syndrome
Phone
Phone
Person completing the form
Name of person completing the form
Name of person completing the form
Declaration
Please select
I understand that whilst attending any Down Syndrome Queensland or Down Syndrome Australia event, photographic images - still and video - may be taken of me and my family members during the course of the proceedings. I may also from time to time forward images of myself and/or my family members to Down Syndrome Queensland. I give permission to Down Syndrome Queensland and Down Syndrome Australia to use the aforementioned images as representations or reproductions for the purposes of advertising, fundraising, awareness raising, information, funding submissions, reporting and any other purpose without need for further consent or permission from me at the discretion of Down Syndrome Queensland or Down Syndrome Australia. I also release and hold harmless Down Syndrome Queensland, Down Syndrome Australia and their contractors, employees and any third party involved in the creation or publication of such material from liability for any claims by me or any third party in connection with the use of the images. I understand all material gathered is subject to the discretion of Down Syndrome Queensland and Down Syndrome Australia. I understand that Down Syndrome Queensland and Down Syndrome Australia may not use all or any of the material gathered. Please note that any use of images that fall outside of direct use by Down Syndrome Queensland or Down Syndrome Australia would seek further approval on an individual basis. Please note this permission is valid for the duration of your membership with Down Syndrome Queensland; however permission may be withdrawn at any time upon written notification.
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.