Event Registration Details SPRING SCHOOL HOLIDAY PROGRAM If you are human, leave this field blank. Contact details First Name * Middle Name Last Name * Date of Birth * Age * Gender * Male Female Residential Address * Suburb * Postcode * Preferred Contact Number Alternate Contact number Email Address I would like to join the AYC mailing list and recieve regular updates on local activities and opportunities * Yes No Photo Authorisation I authorise Auburn Youth Centre staff and volunteers to take my photo for use in AYC publications and for purposes to promote the centre and related programs, and understand these photos will be used on the Internet. Medical Information Allergies * Please separate each individual entry with a comma or enter N/A if applicant possesses no known allergies Are you asthmatic? * Yes No Medicare Number Medicare Card Number Special Dietary Requirements (e.g. lactose intolerant, gluten free) Other Medical Information Enter any other relevant medical information Emergency Contact Emergency Contact Name * Emergency contact must be over the age of 18 Relationship * Applicant's relationship with emergency contact Primary contact number * Emergency contact's primary contact number (landline or mobile) Secondary contact number * Emergency contact's secondary contact number (landline or mobile) Demographic Information Demographics Receiving government benefit Low income earner (household) Unaccompanied minor Living within the Cumberland LGA Aged between 12-19 years old Aged 19 - 24 AYC ACTIVITIES (Week 1) 28th September Cooking 12 - 3 29th September Hip Hop 3-5pm Mural Painting 1st October Box Castles 2nd October GIANT GAMES AYC Activities Week 2 * 5th OCTOBER CLOSED PUBLIC HOLIDAY 6th October HIP HOP 3-5PM 7TH October - Mural Painting 8th October Lunch with a female Cop 1pm - 3pm 9th October - COOKING
SPRING SCHOOL HOLIDAY PROGRAM If you are human, leave this field blank. Contact details First Name * Middle Name Last Name * Date of Birth * Age * Gender * Male Female Residential Address * Suburb * Postcode * Preferred Contact Number Alternate Contact number Email Address I would like to join the AYC mailing list and recieve regular updates on local activities and opportunities * Yes No Photo Authorisation I authorise Auburn Youth Centre staff and volunteers to take my photo for use in AYC publications and for purposes to promote the centre and related programs, and understand these photos will be used on the Internet. Medical Information Allergies * Please separate each individual entry with a comma or enter N/A if applicant possesses no known allergies Are you asthmatic? * Yes No Medicare Number Medicare Card Number Special Dietary Requirements (e.g. lactose intolerant, gluten free) Other Medical Information Enter any other relevant medical information Emergency Contact Emergency Contact Name * Emergency contact must be over the age of 18 Relationship * Applicant's relationship with emergency contact Primary contact number * Emergency contact's primary contact number (landline or mobile) Secondary contact number * Emergency contact's secondary contact number (landline or mobile) Demographic Information Demographics Receiving government benefit Low income earner (household) Unaccompanied minor Living within the Cumberland LGA Aged between 12-19 years old Aged 19 - 24 AYC ACTIVITIES (Week 1) 28th September Cooking 12 - 3 29th September Hip Hop 3-5pm Mural Painting 1st October Box Castles 2nd October GIANT GAMES AYC Activities Week 2 * 5th OCTOBER CLOSED PUBLIC HOLIDAY 6th October HIP HOP 3-5PM 7TH October - Mural Painting 8th October Lunch with a female Cop 1pm - 3pm 9th October - COOKING
