City of Joondalup Form Services – A Global City: Bold | Creative

Youth development membership form

Facebook

This field is for validation purposes and should be left unchanged.

Young Person's Details(Required)

Given Name Surname

Gender(Required)

Does the young person identify as Aboriginal and/or Torres Strait Islander or Culturally and Linguistically diverse?(Required)

If yes, please indicate

Aboriginal

Torres Strait Islander

CALD

Date of Birth(Required)

Young Person's Address(Required)

Street Address Address Line 2 Suburb Postcode

Mobile Phone(Required)

Email(Required)

Parent/Guardian details…

Address…(Required)

Address is the same as the young person applying

Address is the not same as the young person applying

Parent/Guardian's Address(Required)

Street Address Address Line 2 Suburb State Postcode

Parent/Guardian's Name(Required)

Given Name Surname

Relation to participant(Required)

Mobile Phone(Required)

Alternate Phone(Required)

Email(Required)

Emergency contact…

(Please provide the details of a person over the age of 18 years other than the parent or guardian already provided on this form)

Given Name(Required)

Surname(Required)

Relation to participant(Required)

Mobile Phone(Required)

Alternate Number

Medical Information

In order to ensure appropriate care, support, and safety, we ask that you provide any information that may influence the named young person’s ability to participate in activities or events. Examples include medical conditions, allergies, disabilities, or mental health considerations.

Consent and Behaviour Participation Agreement

It is a requirement of our program that all participants engaging with the City of Joondalup’s Youth Development programs complete a Participation Agreement. I agree to:

Treat the centre, staff, other participants, and myself with respect

Care for the safety, wellbeing, and property of everyone in the group

Take responsibility for my behaviour and understand how it affects others

If I do not follow this agreement, staff will respond by:

Reminding me of the expected standards of behaviour

Giving me the chance to adjust my behaviour

Asking me to take a short break from the activity or event

If I continue to disregard the standards, requiring me to leave the program/service for a period of time decided by staff in line with City policies.

Has the participant read and understood the consent and Behaviour Participation agreement above?(Required)

Please tick if the participant agrees with the above agreement

Parent/Guardian/Over 18’s Agreement

In the case of an accident or illness whilst participating in the service, program or event, I give consent to the City to provide any necessary medical treatment and agree to meet any expenses incurred. I also give permission for the named young person to be transported to outside medical facilities for treatment if necessary.

I acknowledge that the City is not liable for any loss, damage or injury to property or person as a consequence of the named young person’s participation in the service, program or event. I also acknowledge that I am liable for any damage to property or injury to another person caused by the named young person

I understand that photos and videos may be taken by City approved photographers whilst the named young person is participating in the service, program or event and that these could be used for promotional purposes. If you do not wish for the named young person to be present in any photos or videos please advise the City’s Youth Development Team in writing via youth.services@joondalup.wa.gov.au.

Have you read and understood the Consent and Behaviour Participation Agreement listed above?*(Required)

I consent as the young person of legal age to my participation in this program subject to the conditions above

I give consent as the parent or guardian of the registered young person to participate in this program subject to the conditions above

Name of person giving consent(Required)

First Last

Date of entry(Required)

If at any time you would like to make changes to any of the above, please do so in writing by contacting the City’s Youth Development Team via youth.services@joondalup.wa.gov.au.

PRIS Collection Notice(Required)

The City of Joondalup collects the personal information provided in this Youth Membership Form to manage youth memberships and facilitate participation in Youth Development programs, services, events and activities. This includes registration, communication, parent or guardian consent where required, emergency contact arrangements, participant support, and the safe and effective delivery of youth programs and services. Providing this information is voluntary. However, if the requested information is not provided, the City may be unable to process the membership or registration request, facilitate participation, or provide appropriate support during Youth Development programs, services, events and activities.

The City may use and disclose this information for the above purposes and directly related purposes. Information may be disclosed to relevant Youth Development staff and, where necessary, emergency services in an emergency. Where the City uses a contracted service provider, system provider or approved third-party platform to support the collection, storage, administration or delivery of Youth Development programs, personal information may also be disclosed to or handled by that provider for those purposes, subject to applicable privacy, confidentiality and information security requirements. Consent may be withdrawn by contacting the City in writing at info@joondalup.wa.gov.au or by calling (08) 9400 4000. Withdrawal of consent may affect the City’s ability to continue facilitating participation or providing support.

For details about how the City handles personal information, including how to request access or correction, refer to the City’s Collection Notice on the privacy webpage.

Yes