Rockingham Youth Reference Group - Expression of Interest Form 2025

Thank you for expressing an interest to volunteer for the Rockingham Youth Reference Group (RYRG). Please note, you must to be aged 15-24 to volunteer for the RYRG. The information you provide is confidential and will not be shared with any other organisation without your permission.

Personal Details

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* 1. Name and pronouns

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* 2. Gender

Male

Female

In another way

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* 3. Date of birth
(DD/MM/YYYY)

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* 4. Age

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* 5. Mobile number

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* 6. Email address

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* 7. Please briefly describe your study, work and/or volunteering experience

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* 8. Do you have any health, accessibility, allergy, or dietary requirements we should know about?

Yes

If yes, please describe:

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* 9. What is your current work/study status?

Employed full time

Employed part time/casual

Student

Other (please specify)

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* 10. Anything else you would like to tell us about?

Declaration

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* 11. If successful in joining the RYRG, I agree to:

Undertake a Volunteer National Police Check at the City’s expense

Undertake a Working With Children Check at the City’s expense

Complete the relevant documentation and permission/consents as requested by the City

To complete your expression of interest, please click the ‘submit’ button below.

Please note: submitting this form does not guarantee a place in the RYRG. An officer will contact you shortly after submission to discuss your Expression of Interest.

Should you have any queries regarding the RYRG, or this form, please contact the Rockingham Youth Centre at youthcentre@rockingham.wa.gov.au or on 9591 0836.

For more information:
Instagram: @RockinghamYouthCentre
Phone: 9591 0836
Email: youthcentre@rockingham.wa.gov.au

100% of survey complete.

Rockingham Youth Reference Group - Expression of Interest Form 2025

Question Title

* 1. Name and pronouns

Question Title

* 2. Gender

Question Title

* 3. Date of birth(DD/MM/YYYY)

Question Title

* 4. Age

Question Title

* 5. Mobile number

Question Title

* 6. Email address

Question Title

* 7. Please briefly describe your study, work and/or volunteering experience

Question Title

* 8. Do you have any health, accessibility, allergy, or dietary requirements we should know about?

Question Title

* 9. What is your current work/study status?

Question Title

* 10. Anything else you would like to tell us about?

Question Title

* 11. If successful in joining the RYRG, I agree to:

* 3. Date of birth
(DD/MM/YYYY)