Service provider sign up form

Complete this form and submit it to sign up as a service provider under the Multi-agency Collaborative Panel Information Sharing Arrangement (PDF, 98 KB) Multi-agency Collaborative Panel Information Sharing Arrangement (DOCX, 59 KB)

INFORMATION SHARING AND SERVICES COORDINATION FOR CHILDREN CHARGED WITH OFFENCES

An asterisk (This field is required) indicates a required field.

ARRANGEMENT UNDER SECTION 297F OF THE YOUTH JUSTICE ACT 1992
Organisation address
Terms of the Arrangement:This field is required
  • the organisation is a non-government entity that provides a service to children;
  • I am authorised to agree on behalf of the organisation that the organisation becomes a service provider under the Arrangement; and
  • I acknowledge that the information I have entered on this form is collected for the purposes of managing the arrangement and will be made available to the Prescribed Entities and Service Providers under the Arrangement.

By clicking the submit button below, the organisation becomes a service provider under the Arrangement.