Love Bites program - School registration form Contact details Name* - required School address* - required School contact name* - required School contact phone* - required School contact email* - required Alternate school contact name Alternate school contact phone Alternate school contact email Love Bites program Please provide 2 potential dates you would like Love Bites to delivered in your school? (Tuesday, Wednesday or Thursday are preferred)* - required How many year 10 students are in your school?* - required Love Bites senior targets students who are 15-17 years old, thus the program is delivered to year 10 students. Can you provide 1 classroom per 25 students on the day?* - required Yes No Would there be tech equipment available in each classroom – such as a desktop computer, projector, projector screen and internet access?* - required Yes No Would there be a room available for students to unwind (breakout room) in the event they find the content too confronting?* - required Yes No Do you give consent for your students to participate in a pre and post survey, which include obtaining personal information? (i.e., date of birth, suburb of residence etc.)* - required Yes No This will be important to help in the continued delivery of the program as well as for funding purposes. Do you give consent for any photos or audio/video material of student created content to be used for promotional material (i.e. social media)?* - required Yes No Will your school be able to seek consent from parents for their children to participate in these surveys?* - required Yes No Love Bites is delivered over one day, which includes structured sessions followed by a creative session that takes the form of a rap workshop and/or a art workshop. Students will be given the option to participate in either one. Which of the following would you and your school agree to participate in?* - required Rap workshop only Art workshop only Both Other (school run workshop) Additional supportSchools can also opt for a: Parent seminar: Love Bites facilitators will present the program to your year 10 parents and will be given the opportunity to direct any questions to them.Student consultation: Love Bites facilitators will present the program to your year 10 students and will be given the opportunity to direct any questions to them as well as feedback. Would your school be interested in...?* - required A parent seminar A student consultation Both Would your school be interested in any additional support unrelated to Love Bites...? Mental health Career development Anti-discrimination Other If you selected 'other' for the previous question, please specify. Would your school staff be interested in being trained up in Love Bites?* - required Yes No To become a Love Bites facilitator involves a 2-day training workshop, where participants learn of the theory and application of the program. Background information Has Love Bites been delivered in your school?* - required Yes No If yes, when was the program delivered at your school? Why would you like Love Bites delivered to your school? What do you hope to achieve by having the program delivered to your school? What are some things we need to consider when engaging with your students? Any other comments Follow-up meeting Can you commit to at least two meetings to link up with the Love Bites coordinators?* - required Yes No This will help the coordinators to confirm important details regarding the workshop. Can you commit to a 1 hour briefing meeting, in which you will meet with the Love Bites facilitators who will be delivering the program and will be asked to provide a quick summary about the school and your students?* - required Yes No When would be the best day/time to arrange a follow up meeting with you? (in the month leading up to the proposed date)* - required AgreementLove Bites aims to provide young people with a safe environment to examine, discuss and explore respectful relationships.Thus, by your school agreeing to take part in Love Bites you agree to:Provide a safe environment in which young people can talk about domestic and family violence and sexual assaultPromote and model respectful relationships for your studentsRaise awareness about domestic and family violence and sexual assaultBring about attitudinal change in relation to domestic and family violence and sexual assaultChallenge gender stereotypes, attitudes, and values that enable for domestic and family violence and sexual assault to continueProvide opportunities for young people to support their friendsTake a collaborative approach in addressing domestic and family violence and sexual assault to continueIntroduce young people to local service providers in an informal setting Do you agree to the above?* - required Yes No Date Mandatory field(s) marked with *
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