Registration Form

Who: Young people aged 17+ and community members
Date: Monday 27 November 2023
Time: 5pm – 8pm
Where: Rockingham Youth Centre, 20 Mackinnon Street, Rockingham

To register your attendance at the activity/event, and for catering purposes, please complete the following questions.

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* 1. Attendee's details

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* 3. Attendee's pronouns

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* 4. If the attendee has any access requirements that staff need to be aware of, please list them below.

Examples may include:
  • medical action plans for allergies/asthma
  • any dietary requirements
  • physical abilities and/or
  • use of mobility aids

Media consent

The City of Rockingham may take photos or videos at programs, workshops and events. This means you/your young person may be included in videos or photos that are used for reasonable promotional purposes. This may include publications, the City of Rockingham website, social media accounts or for internal presentations.

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* 5. As the 18+ attendee or legal parent/guardian of the attendee, do you give permission for the City of Rockingham to take and use videos and photos of you/your young person for the media purposes stated above?

Event terms and conditions

The City of Rockingham Youth Centre (RYC) aims to provide a safe and welcoming environment for young people. Our staff will do all they can to make sure all young people are safe while attending our premises and participating in events/activities. 

I understand that if I/my young person is involved in a medical emergency (determined by Centre staff), emergency and/or ambulance services may be requested and I agree to meet any expenses incurred for that service, treatment and/or transport.

All RYC activities and events are alcohol, smoke and drug free. I understand that if I/my young person does not abide by the responsibilities and regulations in place, I/they may be asked to leave the event.

I understand that the City of Rockingham does not hold the authority to keep young person’s at the Centre at the request of parents/guardians. The City of Rockingham does not take responsibility for young people who leave the Youth Centre or who are not on the premises.

I acknowledge that the City of Rockingham will not be liable for loss, damage or injury to property or person that may occur whilst attending the Rockingham Youth Centre or RYC events/activities.

Please note: if you do not provide prior consent to the terms and conditions above, the young person cannot attend the event/activity.

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* 6. Do you as the 18+ attendee, or legal parent/guardian/carer agree to the event terms and conditions above?

Finalise your registration to attend the activity by clicking the submit button below.

RYC blue on white logo
For more information:

Phone: 9591 0836