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  • Carer Details

    Complete this section if person above is under 18 years of age or unable to consent independently.
  • Max. file size: 1,000 MB.
  • Exchange of Information

  • Consent to Receive Services

  • Consent to Use Photos/Digital Recordings/Original Material

    I/we consent to photos/digital recordings/original material of the client listed on page 1 of this form being captured and used:
  • Copyright in all photos, digital recordings and other materials of Autism SA will be owned solely by Autism SA.
  • Information Services

  • Research Participation

  • Privacy & Your Information

  • Policy Statement

    Autism SA collects and stores information (including personal information, as defined in the Privacy Act 1988 (Cth)) that is essential to provide services, engage in research and for reporting and accountability requirements. Autism SA is bound by the Privacy Act 1988 (Cth) and the National Privacy Principles under the Privacy Amendment (Private Sector) Act 2000 (Cth). Autism SA recognises the rights of clients to access, update and correct this information, as described in detail in the Autism SA Client Privacy Policy.
  • Signatures

    Parent(s)/legal guardian(s) must sign if the person is under 18 years or unable to sign independentlyYou will be contacted by Autism SA to renew your consent from time to time. You can update or withdraw consent at any time by notifying Autism SA in writing.