TopBlokes Registration

Registering your young man

Top Blokes Foundation – a youth mental health for-purpose organisation – helps boys and young men build confidence, resilience, empathy and positive decision-making skills.

Small groups

Delivered on school grounds by qualified Youth Workers and mentors.

Real conversations

Topics may include mental health, friendships, respectful relationships (pornography in high school), online behaviour, emotional regulation and more.

Support at home

We send short updates and tips to help keep the conversation going at home.

1Program

2Participant

3Parent/Carer

4Communications

5Permissions

6Review

Program details

Our small-group workshops, led by qualified Youth Workers, help boys build confidence, make healthy choices, and develop leadership skills. Learn more at www.topblokes.org.au.

You are registering your young person for the following program:

School

Term

Year

Young person details

First Name(Required)

Last Name(Required)

Residential Postcode

Date of Birth(Required)

DD slash MM slash YYYY

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Calculated Age

Does the participant identify as Aboriginal or Torres Strait Islander?

Yes, Aboriginal

Yes, Torres Strait Islander

Yes, Aboriginal and Torres Strait Islander

Prefer not to say

Does the participant speak another language other than English at home?

English

Other Language or Languages

Prefer not to say

Please specify the other language(s)

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Does your young man have any medical, allergy or accessibility needs we should know about?

Yes

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Please specify any medical, allergy or accessibility requirements

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Is there anything our Youth Workers should know to safely support your young man?

This may include health, wellbeing, learning, access, cultural, behavioural or family information that would help us support him appropriately.

Parent/Carer Details

Please provide the details of the parent, carer or legal guardian completing this registration.

First Name(Required)

Surname(Required)

Mobile Phone(Required)

Email(Required)

Relationship to young person

Explain the relation to the young person

Mobile number

Email Address

Keep me in the loop

We’d love to stay connected. We occasionally share helpful resources, good news stories, program updates, events and ways to support boys and young men.

Keep me in the loop with Top Blokes news

Yes, I want to be kept up to date with Top Blokes

You can unsubscribe at any time.

Communications & Support

A conversation with a trusted adult can make a real difference in a young man’s life. The fact that you’re here, showing up for him, already matters.

While your young man is in the Top Blokes program, we’ll send short updates to help keep the conversation going at home. These may include a quick SMS or email about what was covered in the workshop, a simple conversation starter, or a helpful resource to support you along the way.

Who should receive these updates?

Please select one:

I would like to receive these updates.

I would like to nominate another trusted adult to receive these updates.

I do not want anyone to receive these updates at this time.

Nominate another trusted adult

Please only add someone if they have agreed to receive SMS and email updates from Top Blokes.

First Name(Required)

Relationship to young person(Required)

Email Address(Required)

Mobile number(Required)

Permissions

Please review and confirm the permissions below.

Evaluation and feedback(Required)

I understand Top Blokes may collect surveys and feedback before and after the program to measure impact and improve the program. You can request the data to be removed post program by emailing info@topblokes.org.au.

Photo and video permission(Required)

Please select one:

Yes, I give permission for photos or videos of my young man taken during the program to be used by Top Blokes in communications, program materials and marketing.

No, I do not give photo or video permission.

Privacy and Data(Required)

I acknowledge that Top Blokes will collect and use the information provided to support program delivery, consent management, communication, reporting and participant safety.

Review

Please check your details before submitting.

Confirmation(Required)

I confirm these details are correct(Required)

Signature(Required)

Welcome to Top Blokes

Registering your young man

Small groups

Real conversations

Support at home

Program details

Young person details

Parent/Carer Details

Keep me in the loop

Communications & Support

Who should receive these updates?

Nominate another trusted adult

Permissions

Review

Your information is safe

Need help?

Contact us at: