This form is for you to discuss your Award activities with your Award Leader prior to starting your Gold Award. Once completed, and signed by participant and Award Leader, please send to the Queensland Award Operating Authority (AOA) for approval.

PARTICIPANT DETAILS

Name		Date of birth		
Email		Phone		
Learner Unique Identifier (LUI)
(10 numbers – not your USI)		Gold start 
date		
Award Centre		

PHYSICAL RECREATION
Activity chosen		
Goal/purpose		
Assessor Name		Role/experience		
Assessor has provided to Award Leader		Signed Volunteer Code of Conduct		Blue Card		

SKILLS
Activity chosen		
Goal/purpose		
Assessor Name		Role/experience		
Assessor has provided to Award Leader		Signed Volunteer Code of Conduct		Blue Card		

VOLUNTARY SERVICE
Activity chosen		
Goal/purpose		
Assessor Name		Role/experience		
Assessor has provided to Award Leader		Signed Volunteer Code of Conduct		Blue Card		

GOLD RESIDENTIAL PROJECT
Activity chosen		
Goal/purpose		
Assessor Name		Role/experience		
Assessor has provided to Award Leader		Signed Volunteer Code of Conduct		Blue Card		

FORM IS CONTINUED OVER THE PAGE
If you’re unsure of activities, sections or requirements, please refer to the Handbook:
https://dukeofed.com.au/resource/handbook/

PRACTICE ADVENTUROUS JOURNEY
Activity chosen		Location		
Goal/purpose		
Supervisor Name		Role/experience		
Is this journey an	Exploration / Expedition / Adventurous Project	NOTE: Adv Projects require prior AOA approval. Please send details with plan.  	

QUALIFYING ADVENTUROUS JOURNEY
Activity chosen		Location		
NOTE: If this activity is different from your Practice AJ, it will not be approved.	
Goal/purpose		
Supervisor Name		Role/experience		
Is this journey an	Exploration / Expedition / Adventurous Project	NOTE: Adv Projects require prior AOA approval. Please send details with plan.  	

Participant and Award Leader to sign below to acknowledge that this plan has been discussed before commencing activities.

PARTICIPANT SIGNATURE		Date		
AWARD LEADER SIGNATURE		Date		

Please send completed and signed form, with any attachments, to the Queensland AOA for approval. Email a clear scan to qld.award.office@qed.qld.gov.au or post to The Duke of Edinburgh’s International Award, GPO Box 919, Brisbane Q 4001.

OFFICE USE ONLY	APPROVED		DATE		

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 Authority, 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.  
	
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 .