ROAR MMA - Nine Week Term 4 Program

Join us at the Rockingham Youth Centre every Wednesday in Term 4 for our MMA program delivered by ROAR MMA.

Whether you're completely new to martial arts or already have some experience, this program is a great opportunity to learn something new, get active and build your confidence.

While this program is 9-weeks long, participation can be flexible and participants are welcome to join anytime throughout the term.

This activity is a part of 'RYC Untamed' - our range of adventure, active and outdoor programs designed for young people to try something new, get moving, build new skills and have fun.

Please note: MMA is inherently physical and hazardous and participation in this program is voluntary and entirely at the participant's own risk. Registration in this activity must be completed by a Parent/Guardian and a waiver must be signed.

This activity is for young people aged 12-17 years.

Date: Wednesdays in Term 4

Week 2: 21 October
Week 3: 28 October
Week 4: 4 November
Week 5: 11 November
Week 6: 18 November
Week 7: 25 November
Week 8: 2 December
Week 9: 9 December
Week 10: 16 December

Time:

12-15 Years: 4pm-4.45pm
15-17 Years: 5pm-5.45pm

Location: Rockingham Youth Centre

Participant details

Question Title

1. Name (Required.)

Question Title

2. Date of birth (Required.)

DOB:

Date

Question Title

3. How do you identify? (Required.)

Male

Female

In another way

Question Title

4. Do you identify as Aboriginal or Torres Strait Islander? (Required.)

Yes

Question Title

5. Where do you live within the City of Rockingham? (Required.)

Baldivis

Cooloongup

East Rockingham

Golden Bay

Hillman

Karnup

Keralup

Peron

Port Kennedy

Rockingham

Safety Bay

Secret Harbour

Shoalwater

Singleton

Waikiki

Warnbro

Other (please specify)

Question Title

6. Please outline any relevant medical information or pre-existing injuries (e.g. asthma, anaphylaxis, epilepsy). (Required.)

Question Title

7. Please outline any accessibility or support needs of the participant. (Required.)

Question Title

8. Does the participant consent to being photographed during the activity and understand that these photos may be used for promotion or publication by the City? (Required.)

Yes

Question Title

9. Which session are you registering for? (Required.)

12-15 Years: 4-4.45pm

15-17 Years: 5-5.45pm

Parent/Guardian details

Question Title

10. Parent/Guardian name (Required.)

Question Title

11. Parent/Guardian email address
NB: additional forms and information will be sent to this email address (Required.)

Question Title

12. Parent/Guardian phone number (Required.)

Question Title

13. I (the Parent/Guardian) understand that participation in activities with ROAR MMA involves inherent risks and that participation is entirely voluntary. (Required.)

Yes

Emergency contact details (if different from Parent/Guardian above)

Question Title

14. Emergency contact details

Thank you for your registration.

Please note that this program is in high demand. We request that you contact youthcentre@rockingham.wa.gov.au should you need to cancel or have further questions.

Registration alone does not confirm a spot on this program. Please keep an eye out for an email from the Rockingham Youth Centre for next steps.

Collection Notice

The City of Rockingham is collecting the personal information provided on this registration for the purpose of contacting you if you secure one of the spots on this Term Program. It may also be used for secondary purposes which would be reasonably expected.

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

If you choose not to provide your personal information, you will not be able to register for this program.

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.

ROAR MMA - Nine Week Term 4 Program

Question Title

* 1. Name (Required.)

Question Title

* 2. Date of birth (Required.)

Question Title

* 3. How do you identify? (Required.)

Question Title

* 4. Do you identify as Aboriginal or Torres Strait Islander? (Required.)

Question Title

* 5. Where do you live within the City of Rockingham? (Required.)

Question Title

* 6. Please outline any relevant medical information or pre-existing injuries (e.g. asthma, anaphylaxis, epilepsy). (Required.)

Question Title

* 7. Please outline any accessibility or support needs of the participant. (Required.)

Question Title

* 8. Does the participant consent to being photographed during the activity and understand that these photos may be used for promotion or publication by the City? (Required.)

Question Title

* 9. Which session are you registering for? (Required.)

Question Title

* 10. Parent/Guardian name (Required.)

Question Title

* 11. Parent/Guardian email addressNB: additional forms and information will be sent to this email address (Required.)

Question Title

* 12. Parent/Guardian phone number (Required.)

Question Title

* 13. I (the Parent/Guardian) understand that participation in activities with ROAR MMA involves inherent risks and that participation is entirely voluntary. (Required.)

Question Title

* 14. Emergency contact details

1. Name (Required.)

2. Date of birth (Required.)

3. How do you identify? (Required.)

4. Do you identify as Aboriginal or Torres Strait Islander? (Required.)

5. Where do you live within the City of Rockingham? (Required.)

6. Please outline any relevant medical information or pre-existing injuries (e.g. asthma, anaphylaxis, epilepsy). (Required.)

7. Please outline any accessibility or support needs of the participant. (Required.)

8. Does the participant consent to being photographed during the activity and understand that these photos may be used for promotion or publication by the City? (Required.)

9. Which session are you registering for? (Required.)

10. Parent/Guardian name (Required.)

11. Parent/Guardian email address
NB: additional forms and information will be sent to this email address (Required.)

12. Parent/Guardian phone number (Required.)

13. I (the Parent/Guardian) understand that participation in activities with ROAR MMA involves inherent risks and that participation is entirely voluntary. (Required.)

14. Emergency contact details