Registration Page for the Empowering YOUTH Program

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* 1. Full name of the young person who will be attending:

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* 2. Age of the young person who will be attending:

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* 3. Name and contact information of the young person's caregiver:

Name

Email Address

Phone Number

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* 4. Which Empowering YOUTH Program is the young person registering to attend:

Alice Springs:
Week 1 of the 2023 Term 3 School Holidays.
9 am to 12 pm on Tuesday the 26th, Wednesday the 27th, Thursday the 28th and Friday the 29th of September 2023.

Darwin:
Saturday mornings, Term 4, 2023
9 am to 12 pm on Saturday the 28th of October, Saturday the 4th of November, Saturday the 18th of November and Saturday the 25th of November 2023.

Palmerston:
Saturday mornings, Term 1, 2024 (dates and times to be advised)

Katherine:
Term 1 School Holidays 2024 (dates and times to be advised)

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* 5. Please confirm that you understand the program is delivered over four sessions:

I understand

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* 6. Please confirm that we can contact the young person and/or their authorized caregiver to discuss ways about ways to support their participation in the program:

I agree

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* 7. Please confirm that both the participant and their authorized care giver agree to this registration:

young person agrees

caregiver agrees