Introducing Spill the Beans, a program designed for young people aged 17–24. 

Come and join us at various cafes throughout the Rockingham area to make new friends and enjoy leisurely activities over a free coffee.

Spill the Beans is presented in partnership with headspace Rockingham and Neami National.

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* 1. What is your full name?

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* 2. What is your preferred name?

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* 3. What are your pronouns?

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* 4. What is your date of birth? (DD/MM/YYYY)

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* 5. What is your gender identity?

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* 6. Do you identify as Aboriginal or Torres Strait Islander?

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* 7. What is your phone number?

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* 8. What is your email address?

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* 9. What suburb do you reside in?

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* 10. How did you hear about Spill the Beans?

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* 11. If you have any allergies or dietary requirements, please indicate them below.

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* 12. If you have any support or accessibility requirements, please indicate them below.

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* 13. Which dates would you like to attend Spill the Beans?

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* 14. The City of Rockingham may take photos or videos at programs, workshops and events. This means you 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. 

Do you give permission for the City of Rockingham to take and use videos and photos of you for the purposes stated above?

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* 15. Terms and Conditions

The City of Rockingham Youth Team aim to provide a safe and welcoming environment and will do all we can to make sure all young people are safe while attending and participating in Spill the Beans. 

I understand that if I am involved in a medical emergency (determined by the Rockingham Youth 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.

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 Spill the Beans.

Spill the Beans is alcohol, smoke and drug free. 

Do you agree to the Terms and Conditions above?

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