Event Registration Details School Vacation 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 12-24 years old AYC ACTIVITIES – WEEK 1 Monday 15th – Dance Class Monday 15th – Music Production Tuesday 16th – Soccer Competition Tuesday 16th – Drop In Wednesday 17th – Sydney Family Show Wednesday 17th – 3 vs 3 Basketball Thursday 18th – Drop In Thursday 18th – Gunnamatta Bay Excursion AYC ACTIVITIES – WEEK 2 Tuesday 23rd – Pizza Making Tuesday 23rd – Volleyball Wednesday 24th – Sushi Making Wednesday 24th – Phoenix Eye Film Making Friday 26th – Snooker Friday 26th – Mural Painting AYC ACTIVITIES – WEEK 3 None
School Vacation 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 12-24 years old AYC ACTIVITIES – WEEK 1 Monday 15th – Dance Class Monday 15th – Music Production Tuesday 16th – Soccer Competition Tuesday 16th – Drop In Wednesday 17th – Sydney Family Show Wednesday 17th – 3 vs 3 Basketball Thursday 18th – Drop In Thursday 18th – Gunnamatta Bay Excursion AYC ACTIVITIES – WEEK 2 Tuesday 23rd – Pizza Making Tuesday 23rd – Volleyball Wednesday 24th – Sushi Making Wednesday 24th – Phoenix Eye Film Making Friday 26th – Snooker Friday 26th – Mural Painting AYC ACTIVITIES – WEEK 3 None
