Youth Week Booking Form Below you can book single or multiple events that you wish to attend at The Youthie during the school holidays and Youth Week! Your Details Full Name* - required Street Address* - required Suburb* - required State* - required Select ACT NSW NT QLD SA TAS VIC WA Postcode* - required Phone Number* - required Date of Birth* - required Email Address* - required Do you consent to Tamworth Regional Council updating their records with the information provided above?* - required Select Yes No I agree to be responsible and conduct myself with the highest integrity whilst participating in events held at the Tamworth Regional Youth Centre. I will remain in designated areas at all times as instructed by Youth Workers.* - required Are you under 18 years of age?* - required Yes No Under 18 Parent/Guardian Full Name* Parent/Guardian Mobile Number* In the event of an accident, I give permission for my child named above to be administered First Aid and to be transported to hospital by ambulance if necessary. I understand every attempt will be made to contact me before acting on this permission. I declare that I am the parent/legal guardian of the following child or children or holder of authorised substituted decision-making responsibility for the following person* Ages and Descriptions of the subjects (children) 18 Years Old Emergency Contact Full Name* Emergency Contact Mobile Number* Do you/your child have a disability or medical condition?* - required Select Yes No Disability or Medical Condition Details Please tick which options apply to you Physical Disability Hard of hearing/Deaf Low vision/Blind Neurological condition Medical condition Dietary Requirements Please provide details of condition Please provide information on any mobility issues Activities Please select the activity session/s you would like to attend* - required BounceBack – Friday 11 April Tamworth's Got Talent: Creative Arts Comp & Disco – Friday 11 April Skate and Novelty Sports Competition – Monday 14 April Stand-up Comedy Workshop with Anthony Lamond – Tuesday 15 April We are the future and the future is now: Public Speaking and Creative Expression Competition – Tuesday 15 April Youth Week Trivia Night – Tuesday 15 April Transport Transport is available from the collection points below. Please chose a collection point to partake in the provided transport. If you require transport please select collection point Youthie Tamworth Barraba Manilla Attunga Media Consent Photographs and/or audiovisual footage may be taken at these events. Definitions and full media consent information here. Do you wish to identify as Aboriginal Torres Strait Islander OtherOther text Media Conditions and limitations (tick & specify those if any that apply). I do not allow my name/the subject's name to be used in association with the images and recordings Media use is subject to the following cultural considerations Please specify cultural considerations Media use is subject to the following other restrictions Please specify other restrictions By checking this box, I hereby grant to Tamworth Regional Council the irrevocable right to take and use Images and Recordings of me and/or the subjects, for the purposes of Publication for any Council purposes in whole or in part, including but not limited to publication on social media, websites, internet broadcasts and any other publications of any kind as released by Council. I have fully informed myself of the consent, indemnity and release (information above) before checking this box.* - required Privacy Statement Personal information supplied to or collected by Tamworth Regional Council will only be stored and processed by Council for lawful purposes directly related to the functions and activities of Council. Any personal information supplied will only be disclosed to a third party for the purpose of performing a lawful function or activity and for no other purpose. Disclosure of personal information to a third party will be in accordance with Tamworth Regional Council's Privacy Management Plan (PDF 331.7KB). Mandatory field(s) marked with *