Gigbuddies Form

Hi, Welcome to the Gig Buddies Sydney participant (Gig Buddy) application form.

Please take a few moments to read the Gig Buddies FAQ, NDIS info and About Us before starting.

The standard charge for Gig Buddies participants is 3 hours per month (see categories on NDIS info webpage) which supports the project with recruiting, vetting, matching & training volunteers to partner with a Participant (adult with a mild to moderate learning disability and/or autism) build a friendship & attend live music, sport as well as any other artistic, recreational or social event.

Gig Buddies provides ongoing support to all participants and volunteers; promoting and supporting social inclusion, enabling an experience beyond the limitations of a disability specific event.
The Gig Buddies Sydney Project is for adults (18+years) with mild to moderate learning disability and/or autism in the greater Sydney area (Sydney and suburbs).

If you do not currently have NDIS funding available for Gig Buddies, please contact Gig Buddies Sydney on 02 9419 6951 or info@gigbuddiessydney.org

This document will automatically save each time you select the "Next" button, so although it will take about 30 minutes to complete you can exit after any save and pick up where you left off by entering your name and date of birth on this page.

If, at any time, you wish to have your data permanently deleted, please contact Gig Buddies Sydney.

If you have any questions please contact Gig Buddies Sydney - 02 9419 6951 or email info@gigbuddiessydney.org

By entering your name and date of birth and clicking "Next" below you agree to the above information.

*This Gig Buddy application was created in collaboration with the "Soul Fly Band", our user led service group.

Your Name

Date of Birth

The Gig Buddies project is an initiative of ACL Disability Services, an organisation with 50 years' experience providing assistance to adults with mild to moderate learning disabilities and autism.

In line with ACL Disability Services' mission statement, the Gig Buddies project only provides assistance to adults with mild to moderate learning disabilities and autism.

Before proceeding with your application, please tick the box below to confirm that you have read and agree to this statement.

I confirm that I have read and understood the above statement

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Please enter the address where you live

Please enter your gender

Please enter your contact telephone number

If you have an email address, please enter it here

If your parent, support worker or carer has an email, please enter it here

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Emergency Contact 1

Name

Relationship to You

Telephone

Address

Emergency Contact 2 (optional)

Name (optional)

Relationship to You (optional)

Telephone (optional)

Address (optional)

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Being in the Gig Buddies project costs 3 hours a month from your NDIS funding. This can come from either your Core Support or Capacity Building funding.

ACL Disability Services will not take any payments or invoice you until we have met with you, and you have signed a Service Agreement.

Please provide us with your NDIS package details below so we are able to create a Service Agreement for you.

*Please contact us if you have any questions:

email: info@gigbuddiessydney.org

phone: ACL Disability Services - 02 9419 6951

Do not worry if you do not have these details to hand, this form saves automatically and you can come back to it later* (click "next" at the end of this page to save first)

*if you need to log back in:

1. click the link on the participant page on the gig buddies website

2. enter your name and date of birth and you will come back to where you left the form

Do you have an NDIS package ?

YES - I have an NDIS package NO - I don't have an NDIS package

If your answer is NO to the above question (or you are unsure)

please don't go any further on this form and Contact Us:

call: (02) 9419 6951 (monday to Friday, 9am to 5pm)

or

email: info@gigbuddiessydney.org

If you do have an NDIS package, please continue with the form below

Please enter your NDIS number below

NDIS Plan START DATE

NDIS Plan END DATE

If yes, how is your NDIS plan managed?

Self-managed Agency-managed Plan Management Service Provider

(from NDIS website)

What are the differences between being plan-managed and self-managed?

When we talk about managing a plan, we mean the way you manage the financial transactions involved with accessing supports as part of your plan. There are three ways to manage plan budgets:

Self-managed budgets- Self-managing your plan means the NDIS will pay you directly for the supports you claim under your plan’s budgets. Being self-managed allows you to choose any provider, whether they are registered with the NDIS or not. Find out more about how self-managing your plan works in the self-managing your plan factsheet.

Agency-managed budgets - When the NDIA manages your plan, the NDIS will directly pay your support providers for you. You have to choose registered NDIS providers if the NDIA manages your plan.

Plan Management - If it’s the best option for you, you may have funding for a Plan Management service provider included in your plan. In this situation, the NDIS will pay your Plan Manager, who will directly pay for all supports you have asked them to manage.

Who manages your plan?

What are the contact details for your NDIS Plan Manager? (email and/or phone number)

Please provide an email address to send NDIS invoice to for payment

What category will your Gig Buddies NDIS funding come from.

Core Support Capacity Building

NDIS Categories for Gig Buddies Project

CORE SUPPORT

Support item Ref No. 04_104_0125_6_1

Establishing volunteer assistance within the Participant’s home or community to develop skills - for instance, taking part in social activities & maintaining contact with others.

OR

CAPACITY BUILDING SUPPORT

Support item Ref No. 09_006_0106_6_3

Supporting a participant to engage in community, social and/or recreational activities.

for full descriptions of each category please click here > Core Support - Capacity Building

or download the NSW NDIS Price Guide pdf HERE

To give you support, the Gig Buddies project needs to keep information about you.

For example, who you are, where you live and what type of support you need.

This is your personal information.

This personal information may be written down and kept in a folder, in a cloud based network, or on a computer.

A law called the Privacy and Personal Information Protection Act NSW 1998 says that the Gig Buddies project must keep this information private and secure.

Only people that need to know your information, so they can give you the support you need, can see it (for example, your support worker).

Sometimes the Gig Buddies project may need to share your personal information with other people involved in your support (e.g. your support provider, or in an emergency with your doctor or the hospital.

This will only happen if you say this is ok using the Permissions Form on the next page, or if we need to keep you safe.

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I understand that Gig Buddies and ACL Disability Services will keep my personal information private.

The Gig Buddies project will only use information about me to make sure I get the right support and to help find me a gig buddy.

I can decide not to let staff share certain information at any time.

I can stop my involvement with the Gig Buddies project and ask to have my personal information removed from the database at anytime.

I understand and agree

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I give the Gig Buddies project permission to share the information in my files with the following people if they need to see it :

Share information with my family

Yes No

Share information with my family but I don't want this discussed :

Share information with my support staff

Yes No

Share information with my Gig Buddy volunteer. (Emergency contacts, Medical information, disability information)

Yes No

Share information with medical staff in an emergency

Yes No

Other information

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The Gig Buddies team may like to use video and/or photos of you at our social events or with your gig buddy. Photos help promote the Gig buddies project to other people.

Videos and photos may be used to help people know about the work of the Gig Buddies project.

Not all photos and video that the Gig Buddies team take are used, but we will use what we can.

The Gig Buddies team may put video or photos of you with your buddy or at a Gig Buddies event on the internet, which means anyone will be able to see it.

They may also use it in leaflets and other publicity (we will ask permission before a photo is used on a brochure or in a news story in a magazine or newspaper).

(We never put participants personal information on the internet)

Do you consent to the Gig Buddies project using video and/or photos of you to help promote our work to other people ?

I understand and agree I do not agree to having my images used

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The Gig Buddies befriending project was developed for adults with mild to moderate learning disability and/or autism.

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In this section we ask you about your disability, medical conditions and support needs.

This will help us to determine if the Gig Buddies project is able to accomodate your support needs.

We feel this is important, as it helps ensure all potential participants can get the best experience from the project.

How much support do you need in your daily life?

I am independent with no support I receive some daily support I need full support I need full support (including *personal care support)

*Personal care (above) refers to the support of personal and private hygiene and toileting. This may include requiring assistance with going to the toilet, cutting up food or a specialist mode of transport to accommodate walking aids or wheelchairs etc

Please tell us more about your primary disability and daily support needs.

As an NDIS eligibility requirement* for the Gig buddies project, a participant's primary disability must be mild to moderate learning disability and/or autism.

*Gig Buddies and ACL Disability Services are NDIS service providers registered to provide support and volunteer social support for adults with mild to moderate learning disability and/or autism.

Do you have any of the following medical conditions ?

If you have other disability and/or medical conditions (or allergies) not listed above please enter them below: (*Please include mental illnesses i.e. anxiety, depression, schizophrenia)

Please list any medications you take ? (in case of emergency)

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What are your Interests/Hobbies ?

Your hobbies/interests can include activities you like to do and things you find interesting, such as; bush walking, science fiction, politics, star gazing, train spotting, cars, motorbikes, planes, knitting, bike riding, types of movies, podcasts you listen to, travelling, swimming, surfing, computer games, cooking, baking, art and craft etc...

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Would you like a male or female gig buddy (volunteer / person to go to gigs with) ?

Female Male I don't mind

Are you able to travel independently on your own ?

Yes No

Please provide more information about your travel (i.e. do you prefer trains?, do you need help with new places? etc)

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Are you comfortable being in crowds (packed buses or trains, sporting crowds, near the stage of a crowded gig), loud places, tight spaces, etc ...?

Yes No

If you are not comfortable in crowds, loud places, tight spaces, please explain

Is there anything that upsets you? Words, expressions, attitudes, environment, bright lights, bullies etc ...?

Yes No

If there are things that upset you, please explain. (e.g. swearing, drinking, smoking, loud noises or music, bright lights, bullies, clowns, balloons, dogs)

70% complete

Do you have any of the following ?

Companion Card Pension Card Photo ID None of these

For more information about NSW Companion Cards, visit https://www.nsw.gov.au/living-in-nsw/companion-card/about-card

Which social media do you use ?

You can keep up to date with the Gig Buddies project on social media. See these links: Facebook - Instagram - YouTube - Twitter

How did you hear about the Gig Buddies project?

If you heard about Gig Buddies from a friend, please enter their name below (so we can thank them!)

If you heard about us from somewhere else, please type in the box below.

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Gig Buddies requests your help. Please complete the following survey based on your experience with the live music scene in your city.

Thank you for your time.

When was the last time you went to a concert ?

Less than one month ago A few months ago More than 6 months ago Never been to a concert

When was the last time you saw a live band in a pub/club ?

Less than one month ago A few months ago More than 6 months ago Never seen a live band in a pub or club

Have you ever been to a music festival ?

Yes No I don't know

If you have been to a music festival, which one was it ?

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Are you a part of any social groups ?

Yes No

If yes, what is the name of your social group/ groups ? - How often do you catch up ? - Where do you catch up ?

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What type of music do you listen to ? (click as many as you like)

Who are your favourite musicians, singers, bands and other types of music not listed above ? (add as many as you like!)

Please tick sports you are interested in:

Please list your favourite sporting teams and other sports you are interested in.

Do you have a favourite place you like to meet your friends or to go out socially ?

Yes No

If yes, what is the name of the place that you visit ?

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If you went out in the evening with a support worker, friend or family member, what would be the latest time that you have stayed out with them ?

If you went out in the evening by yourself, what would be the latest time that you have stayed out ?

If you went out in the evening with a support worker to meet friends or go to an event, have you had to leave early because the support worker was finishing their shift ?

If given the opportunity, would you like to go and see live music, sport matches or attend music festivals/community festivals ?

Yes No Maybe not applicable

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One last question!... In your own words, please tell us what your goals are with Gig Buddies ? (a few words will do)

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Thank you very much for taking the time to complete this survey. In order to complete the survey please read our Privacy and collection of information policy. Your feedback is valued and very much appreciated!.

Want to keep up-to-date with the latest Gig Buddies news?

Yes. I would like to receive your weekly email newsletter No Thanks

Click HERE to subscribe to our newsletter* now.

*Weekly email with updates to events and other fun information.

Privacy and collection of information policy

ACL Disability Services is committed to taking all reasonable steps in order to protect your privacy and personal information from misuse, loss or unauthorised access, modification or disclosure.

Your personal information provided to ACL Disability Services will be held in hard copy and managed in a secure recruitment file. Access is restricted to ACL Disability Services personnel and on a need to know basis.

Your name will not be used in any data results that are collated by ACL Disability Services and will not be given to any third parties.

ACL Disability Services will retain your information on a secure database and your information will be kept for no longer than necessary. In any event, ACL Disability Services will securely remove your information 2 years after the date that the survey was completed. If you request your personal information be removed from ACL Disability Services records, we will ensure reasonable steps are taken to promptly and securely dispose of your information.

I accept and agree to the above Privacy and collection of information policy I do not agree to the above Privacy and collection of information policy and do not wish for my information to be used for the purpose of this survey