REKON Youth Foundation - Wilbur Street Youth Registration

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* 1. Date of Registration

Date

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* 2. Young Person's Details

First Name

Surname

Street Name and Number

Suburb

Postcode

Phone Number

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* 3. What is your gender?

Female

Male

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* 4. What is your age?

24 and over

Other (please specify)

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* 5. Parent/Guardian Details

First Name

Surname

Relationship to young person e.g Mother, Father, Carer

Phone Number

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* 6. Which ethnicity best describes you?

Aboriginal/Torres Strait Islander

Samoan

Tongan

Fijian

Maori

African

Latino

Asian

Australian

New Zealander

Middle Eastern

European

Other (please specify)

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* 7. Where would/did you attend the REKON program?

Logan Central

Yarrabilba

Loganlea

Springfield Central

Newmarket

Mango Hill

Deception Bay

Marsden

Ipswich

Northside

Other

Other (please specify)

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* 8. Which activity would you like to participate in at REKON?

Dj/Beat making

Music Recording

T-Shirt creation

Sport

Street Art

Hip Hop Dance

Table Tennis

Pool Table

Gaming

Barbering

Barista

Cultural

REKON Youth Foundation - Wilbur Street Youth Registration

Question Title

* 1. Date of Registration

Question Title

* 2. Young Person's Details

Question Title

* 3. What is your gender?

Question Title

* 4. What is your age?

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* 5. Parent/Guardian Details

Question Title

* 6. Which ethnicity best describes you?

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* 7. Where would/did you attend the REKON program?

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* 8. Which activity would you like to participate in at REKON?

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* 9. What other activity would you like to do?