Client Consent Form – Parent or Guardian on Behalf of a Child or Young Person
To enable us to provide effective and appropriate services to all of our clients, Relationships Australia Tasmania (RA Tas) needs to collect some basic personal information about you, which may include name, contact information, age, gender and indigenous status, as well as information on the issues and concerns you are seeking to address.
This information – ‘client data’ – is stored on a secure and sophisticated computer-based client management data system, as well as in individual, paper-based client files. Access to this information is restricted to authorised persons only. Your consent is needed to store your information and to contact you at a later date for follow-up, evaluation and/or research purposes.
If you have provided your email address during intake for RA Tas to contact you at a later date for follow up, evaluation and/or research, please be aware that RA Tas may use email distribution software such as MailChimp in order to contact you. In this event your email address and first name only will be stored on the software provider’s server which is located in the United States. Your involvement in providing this information is completely voluntary and you may withdraw your consent at any time.
We receive funding from State or Commonwealth Governments to provide services. As part of their funding, they may require us to provide them with general information about people using our services and whether the services are helpful. Funding bodies cannot access identifying details like your name when they get this general information. In other words, you cannot be identified when this information is provided to our funders.
RA Tas funding bodies may require us to demonstrate continuous quality improvement and safety activities in accordance with service delivery standards. In order for audits to be conducted there are times when external auditing parties will request to view files to ensure that the correct processes are being followed and the correct documents are being used. The auditors do not read file notes or personal information. You are under no obligation to authorise your file to be used for this purpose.
RA Tas respects your privacy and is committed to ensuring personal information is managed in accordance with the Australian Privacy Principles as contained within the Privacy Act 1988 (Cth). In addition to this, depending on what services you are seeking, you may also be protected by legislation, such as the Family Law Act 1975 (Cth), Personal Information Protection Act 2004 (Tas), the Children, Young Persons & Their Families Act 1997 (Tas).
Please read the Your Privacy and Confidentiality Factsheet provided with this form. For further information about how RA Tas manages your personal information, please request a copy of our Privacy and Confidentiality Policy, by contacting Relationships Australia Tasmania on 1300 364 277 or asking your practitioner. A copy of the Policy can also be obtained from the RA Tas website.