Diversity Group Registration

Welcome to the headspace Bendigo Diversity Groups. Please complete the registration form that will assist us to gather important information about you, and to ensure you are well supported during the group. The diversity worker will discuss privacy and confidentiality with you as part of the registration process, including how your information will be used.

Upon receiving the completed registration form, the diversity worker will send you an email/SMS with details for the diversity group which coincides with your age group.

First Name - as on Medicare card *

Last Name *

Affirmed/Preferred name

Date of birth *

Gender identity *

Sex assigned at birth *

Do you identify as LQBTIQA+ and/or ally? *

Please specify

Contact number. This will be the number SMS messages will be sent to. *

Email Address *

Address *

What is your preferred method of contact regarding group reminders? *

About you

It is helpful for us to know a bit about your background. Please only share information you are comfortable with and think might assist you to have a positive experience in group.

Have you been diagnosed with a medical condition (mental or physical)? *

Yes No

If yes, please state . How can we best support you during groups? How can we make the space more accessible and welcoming for you?

Do you have any other health and wellbeing issues? *

YesNoUnsure

If yes, please state

What professional or other supports do you currently have? *

Do you need more support? If yes, please complete the self referral form on the headsapce Bendigo website *

YesNoUnsure

What risk factors/triggers do we need to be aware of? *

Is there any other information we should know about? (eg. family issues, living arrangements, relationships, employment, study, issues with alcohol and other drugs) *

Do you identify as Aboriginal or Torres Straight Islander? *

YesNo

How would you describe your cultural background? (eg. Australian, Karen ect) *

Do you have any allergies? Please specify *

Emergency contacts

Please provide contact person/s in case of an emergency, including any information you would not want us to disclose to an emergency contact.

(e.g. sexuality, gender identity, pronouns).

Person 1

Name *

Contact number *

Relationship to you *

Knows you as (name, gender, ect) *

Person 2

Name

Contact number

Relationship to you

Know you as (name, gender, ect)

PLEASE NOTE: If your family are not aware of your identity, please let the Diversity Worker know.

Code of Conduct

Welcome to Diversity Group

Being a headspace Bendigo Diversity Group member is a great opportunity to promote the positive image of young LGBTIQA+ people as well as mental health. Your behaviour as a member of Diversity Group should enhance the reputation of headspace Bendigo and what it stands for, as well as being considerate of other members’ needs.

Group Logistics

Diversity Groups are headspace Bendigo’s social support groups for LGBTIQA+ young people who are between 12-25 years of age.

Diversity Groups hope to:

Provide you with a safe space to be yourself.
Provide opportunities for you to share and learn information relating to LGBTIQA+ young people.
Provide a place for you to meet and form friendships with other young people who are going through a similar experience to you.
Allow you to participate in local LGBTIQA+ related activities and events.
Encourage you to be involved in planning and organising LGBTIQA+ activities and events to be facilitated by headspace Bendigo.

Participation Requirements

headspace Bendigo recognises that individuals have different commitments outside of Diversity Group. Due to high interest for the diversity groups, we have made some small changes starting in 2025. If you haven't attended a diveristy group for four consecutive weeks, the diveristy worker will be in contact with you and discuss your attendance further. This may mean placing you on our stand-by list so other young people will have the opportunity to attend groups.

If you no longer wish to attend group, please let the diversity worker know via, email, phone call or SMS.

Please Note: You are only to attend the group that is for your age.

FROGS– Full Range Of Gender and Sexuality, Wednesdays from 4:00-5:30pm 18-25 years of age.

TADPOLES– Trans And Diverse People Openly Loving Everyones Sexuality, Thursdays from 4:00pm – 5:30pm 15-17 years of age.

POND - People Openly Nurturing Diversity - Tuesdays from 4-5.30pm 12-14 years of age

Diversity Group Guidelines

Be inclusive and respectful of others – no name-calling, discriminatory language, hate speech, subtle racist/sexist comments or jokes, peoples abilities, mental/physical health or physical presentation.
Be kind and considerate to the diverse ways in which we communicate. If you have a preferred method of communication, please notify the facilitator to ensure our group is a welcoming, inclusive and accessible space.
There is no pressure to share any personal information you do not feel comfortable with.
Use inclusive language during group times, if unsure please ask and consider how your words will affect others.
Do not pressure anyone to share any personal information, conversations/activities that may not feel comfortable doing.
People’s personal identities are personal, they know themselves better than you know them, don’t argue about their gender/identity/sexuality.
Do not be afraid to ask questions – this is how we learn
Everything spoken about during meetings should remain private and confidential – do not use any group members name or other personal details when talking or sharing stories outside of the group. Remember this is a safe space and not all who attend group are publicly out to family/friends. We need to always protect everyones privacy.
Don’t make any assumptions about group members. How we introduce ourselves in our introductions is how we address each other. E.g., names and pronouns
Be patient with those who are still learning or willing to learn and accept that you don’t know and have more to learn.
Be respectful and mindful of noise levels, as young people do have sensory requirements that must be taken into consideration.
Ask to talk to the group facilitator one-on-one if there is something you want to discuss privately. If there are any issues within the group during group time, please bring them to the facilitator so they can be addressed as soon as possible.
The group facilitator’s work mobile is only accessed Monday - Thursday, 9am-5pm. The mobile is used to contact Diversity Group members about meetings and activities. Only contact the facilitators work mobile in response to the facilitator or for matters relating to Diversity Group. The mobile is not to be contacted in emergency or crisis situations (see below for these contact numbers).

Problem Solving & Dispute Resolution

Any complaint, unresolved problem or serious dispute that involves Diversity Group members is to be brought to the Diversity Group facilitator for resolution. If appropriate, and with the agreement of all parties, the matter may involve a mediation process. A range of mediation options will be made available.

headspace Bendigo reserves the right to exclude any young person if headspace Bendigo believes the young person has acted inappropriately (this may include violence/fighting, verbal abuse, bringing down the name of the group or headspace Bendigo, causing other group members to feel distressed, etc.). If such steps are taken, the member’s participation with Diversity Group will be reassessed with their consultation and may mean a predetermined timeframe of exclusion from the group or immediate expulsion.

Care and Support for Diversity Group Members

headspace Bendigo promotes early intervention and help-seeking for mental health and drug and alcohol issues. It is therefore expected, that as a representative of headspace Bendigo, you acknowledge this and you yourself seek appropriate supports when required. Therefore, if at any time you feel you need to take a break, seek help or support then headspace Bendigo will respect this.

It is important if you (or another group member) are feeling mentally unwell or are in a crisis situation and believe that you are at risk to yourself or others, that you contact a trusted adult or an appropriate support service to get the right help. These services and their contact details are listed below:

Regional Triage/Psychiatric Services (24/7)– 1300 363 788

Police or Ambulance (24/7 and complete welfare checks or transport to hospital)– 000

Lifeline (24/7)– lifeline.org.au or 13 11 14

Kids Helpline (24/7)– kidshelp.org.au or 1800 55 1800

eheadspace (7 days, 9am-1am)– eheadspace.org.au or 1800 650 890

Qheadspace- online

Rainbow Door- rainbowdoor.org.au or 1800 729 367

headspace Bendigo– 5406 1400 (not a crisis service)

I have read the information contained in this document and agree to abide by the Diversity Group Code of Conduct.

Name *

Signature *

Draw signature|Type signatureClear

Date *

If you are under 16 years of age, you will need a parent/guardian/carer permission to attend diversity groups.

I give my permisson for my dependant to participate in the headspace Bendigo Diversity Group

Name

Signature

Draw signature|Type signatureClear

Date