Blue Card Services Department of Justice and Attorney-General Link an applicant/cardholder to this organisation Working with Children (Risk Management and Screening) Act 2000 This form is to be completed by applicants/cardholders who have applied for, or hold a blue/exemption card to advise they are undertaking child-related activities with a new or additional organisation. (to be completed by the organisation) Part C Organisation details – Name of organisation Organisation Contact person’s name 1 4 2 ID number (if known) Postal 5 Contact person’s position 3 address of organisation Telephone 6 Email 7 Postcode Part D Category of child related activity (to be completed by the organisation) – Information about categories of child-related employment and whether any exemptions apply is available from Please select the type of child-related activity to which the employment relates: Child accommodation services including home stays Health, counselling and support services (including Child care (excluding family day care) disability services) Churches, clubs and associations Licensed care services Local Education programs conducted outside school Government (suspended or excluded students or fl xible Paid private teaching, coaching or tutoring Religious arrangements under the Education (General Provisions) representatives Act 2006) Residential facilities Emergency services program School boarding houses Family day care School crossing supervisors Carer Schools (other than registered teachers and parents) Sport Adult Member and active recreation DJAG 008.V3 APR18
Blue Card Services Department of Justice and Attorney-General Link an applicant/cardholder to this organisation Working with Children (Risk Management and Screening) Act 2000 This form is to be completed by applicants/cardholders who have applied for, or hold a blue/exemption card to advise they are undertaking child-related activities with a new or additional organisation. Part C – Organisation details (to be completed by the organisation) 1 2 3 Name of organisation Organisation ID number (if known) Postal address of organisation Postcode 4 5 6 7 Contact person’s name Contact person’s position Telephone Email Part D – Category of child related activity (to be completed by the organisation) Information about categories of child-related employment and whether any exemptions apply is available from Please select the type of child-related activity to which the employment relates: Child accommodation services including home stays Child care (excluding family day care) Churches, clubs and associations Education programs conducted outside school (suspended or excluded students or fl xible arrangements under the Education (General Provisions) Act 2006) Emergency services program Family day care Carer Adult Member Health, counselling and support services (including disability services) Licensed care services Local Government Paid private teaching, coaching or tutoring Religious representatives Residential facilities School boarding houses School crossing supervisors Schools (other than registered teachers and parents) Sport and active recreation DJAG 008.V3 APR18
confirm-valid-card-application.docx