This course is for young people aged 14 -24 years.

Session One
Date: Tuesday 14 July 2026
Time: 10:30am - 12.30pm
Location: Rockingham Youth Centre

Question Title

* 1. Name of participant

Question Title

* 2. Participant's date of birth

Question Title

* 3. Participant's email address (certificates will be sent here)

Question Title

* 4. Contact number for participant

Question Title

* 5. Provide additional contact information for the registration if required
(e.g. parent, teacher, case worker, youth worker, support worker etc.).

Question Title

* 6. Outline any accessibility or support needs of the participant.
Please provide further details below.

Question Title

* 7. Does the participant have any dietary requirements?
Please provide details below.

Question Title

* 8. I consent to being photographed during the course and understand these photos may be used for promotion and publication by the City.

Thank you for your registration, a confirmation email will be sent to registered participants closer to the course date.

Please note this course has limited places and is in high demand.

We request that you contact youthcentre@rockingham.wa.gov.au should you need to cancel or have further questions.
CITY PRIVACY NOTICE
The City of Rockingham is collecting the personal information provided on this form for the purposes of registering for a place on one of the Level Up Certified Courses at the Rockingham Youth Centre. It may also be used for secondary purposes which would be reasonably expected.

We will share this information with the facilitator to administer the course.

If you choose not to provide the personal information, you will not be able to register for the course.

To access, correct or learn more about how we handle personal information please contact privacy@rockingham.wa.gov.au or visit rockingham.wa.gov.au/privacy.
( Privacy & Cookie Notice

T