Fundraising Application Online Form

Thank you for your interest in fundraising for headspace. If you would like to fundraise for a specific centre, please reach out to the headspace centre directly.

Application contact details

Contact Name:

Organisation (if applicable):

Address:

Town/Suburb:

State:

Postcode:

Email:

Phone Number:

Details of your fundraiser

Please tell us why you have chosen to fundraise for headspace:

Name of your fundraiser:

Brief description of your fundraiser:

Proposed date of your fundraiser:

Location of your fundraiser:

Are there any potential sponsors, non-proftits/charities or other organisations involved in your fundraiser? If so, please list them?

Will there be any alcohol available or sold at your fundraiser?

How will you promote your fundraiser?

How much do you hope to raise for headspace?

What, if any, insurance coverage are you required to have for your proposed fundraiser?

Before you submit your application please read the headspace Fundraising Guidelines for your state or territory.

ACT
NS W
NT
QLD
SA
TAS
VIC
WA

Declaration

By submitting this application, I declare that I have read headspace's Guidelines for my state and agree to be bound by them.

I warrant that I have complied, and will comply, with any requirements of the local authorities to conduct the headspace fundraising event.

I warrant that I have obtained all necessary consents and approvals to conduct the headspace fundraising event.

If you are under the age of 18 your parent or guardian must make the application and assume responsibility for compliance with these Terms.

Name of the applicant (or person who by their signature warrants that they are authorised to sign this declaration on behalf of the application)

Date

If you are under 18 years of age, please provide the name and contact details of a parent, carer or guardian. Or if you are conducting a school fundraiser, please provide the contact information for your teacher

Name

Phone Number

Email Address

The funds are being raised to support the national work of headspace.

(If you are looking to support your local headspace centre then you will need to reach out to that centre directly, via the find a centre page)