Name of Organisation (Award Centre Name)		ABN	

Postal Address		
		Postcode		

Street Address		
		Postcode		
Website		Phone		

Senior Officer	Title	Full Name		
	Job Title (i.e. Principal, Director, etc.)		
	Phone	(Work)	(Mobile)	
	Email		

Admin/finance support person	Title	Full Name		
	Job Title (i.e. Admin, Finance, etc.)		
	Phone	(Work)	
	Email		

Award Leader

You will be registered on
the Online Record Book (ORB) as the main Award 
Leader. Please confirm you have:

1.	read the ORB terms and conditions and agree to them □ 

2.	read and understand the Role and Responsibilities of an Award Leader and agree to them □

3.	read the Privacy Policy and agree to it □

	Title	Full Name		
	Job Title (i.e. Teacher, Youth Worker)		
	Date of birth		Please indicate below if you give consent to the following
details being released to participants and volunteers	
	Date started as Duke of Ed volunteer			

Phone	(Work)	Yes			No			
		(Home)	Yes			No			
		(Mobile)	Yes			No			
	Email Address/es		Yes	No	
	Are you a Duke of Edinburgh’s International Award Holder? If yes, please tick which level/s.	
No				
			Bronze		Silver			Gold			
	Do you give permission for the Department of Education to provide you with information on youth initiatives from other government and non-government agencies?	
Yes	
No	
	Volunteer Code of Conduct form completed and maintained at Award Centre
https://www.qld.gov.au/ data/assets/pdf_file/0017/52064/volunteer-code-of- conduct-form.pdf	
Yes	
No	
	Online training module 1 completed
https://learningplace.eq.edu.au/cx/resources/file/a33d9027-1492-4a1e-9864-530af9cef7e3/1/index.html 	Date of completion: DDMMYYYY	
	Are you registered as an Adventurous Journey Supervisor?
If you’re unsure of your status, please check with the AOA	No	Yes –
Outdoor	Yes – Urban	

Award Centre Name		

Other Duke of Ed Volunteer/s (do not list Assessors here)	Title		
	Full Name		
	Job Title (i.e. Teacher, Youth Worker)		
	Duke of Ed Role		
	Date of birth		
	Date started as a Duke of Ed volunteer		Please indicate below if you give consent to the following details being released to participants and volunteers	
	
Phone	(Work)	Yes	No	
		(Home)	Yes	No	
		(Mobile)	Yes	No	
	Email Address/es		Yes	No	
	Are you a Duke of Edinburgh’s International Award Holder? If yes, please tick which levels	No	Bronze	Silver	Gold	
	Do you give permission for the Department of Education to provide you with information on youth initiatives from other government and non-government agencies?	Yes 	No	
	Volunteer Code of Conduct form completed and maintained at Award Centre https://www.qld.gov.au/ data/assets/pdf_file/0017/52064/volunteer-code-of- conduct-form.pdf	Yes	No	
	Online training module 1 completed
https://learningplace.eq.edu.au/cx/resources/file/a33d9027-1492-4a1e-9864- 530af9cef7e3/1/index.html	Date of completion:	
	Are you registered as an Adventurous Journey Supervisor?	
If you’re unsure of your status, please check with the AOA	No	Yes – Outdoor	Yes - Urban	

Does this person require access to the Online Record Book (ORB)?
	Yes
	No	
	If yes, please note that this person will have the same access as the Award Leader	
Note: copy this page to add additional volunteers 
BLUE CARD: Under the Working with Children (Risk Management and Screening) Act 2000 people working with children under 18 years of age in certain categories of business or employment must undergo the Working with Children Check. The Working with Children Check (blue card system) applies to employees or volunteers associated with The Duke of Edinburgh’s International Award and Bridge Award programs. Employers and businesses providing regulated child-related services are also required to have a child and youth risk management strategy in place to protect children and young people from harm.
For more information on whether you are required to hold a blue card or develop and implement a child and youth risk management strategy, please visit the Blue Card Services website at www.qld.gov.au/bluecard or call Blue Card Services on 1800 113 611 (free call). You can also read the fact sheet for The Duke of Edinburgh’s International Award at https://www.publications.qld.gov.au/dataset/blue-card-system-changes/resource/5963ee66-8a39-4aac-aa1c-2e9368da0f6f .

YOUR PRIVACY: The Department of Education is collecting the personal information you provide to facilitate your involvement in the Award program. This will include the personal information that you submit via the Online Record Book Participant Registration Form. Your personal information will only be accessed by authorised officers who may provide the information to Award volunteers and organisations associated with the Award program to facilitate the Award program and to update and maintain records. Such as mail outs regarding award program information, award presentations and the alumni. Non-identifying statistical information may also be supplied to the National Award Operator, a non-government organisation that oversees the Award program In Australia. Your personal information will not be used for any other purpose or disclosed to any other party unless we have your consent or it is required by law. Your personal information is collected and managed in accordance with the Privacy Principles described in the Schedule 3 of the Information Privacy Act 2009 and, if applicable, in accordance with section 426 of the Education (General Provisions) Act 2006. You can access your own personal information by contacting the Queensland Award Operating Authority. By completing this form I give my consent for the Department of Education to collect and store my personal information which may be used for the purposes outlined above.	
PLEASE FORWARD THIS FORM TO THE QUEENSLAND AWARD OPERATING AUTHORITY
Email: qld.award.office@qed.qld.gov.au or Post: GPO Box 919, Brisbane Qld 4001	
AWARD OPERATING AUTHORITY USE ONLY	
Invoice No.		Invoice date		Date processed	
Receipt No.		Receipt date		Customer No.