YMCA South Australia Junior Parliament 2023 Application

Participant Application Form

Click 'NEXT' to begin

JUNIOR PARLIAMENT OVERVIEW

Make sure you read the JP2024 Overview before you apply.

WHAT IS JUNIOR PARLIAMENT?
YMCA SA Junior Parliament is an non-partisan program that gives young people aged 12-15 an opportunity to learn about democracy, parliament, public speaking and leadership in a fun and supportive environment. It focuses on empowerment, personal development and confidence building!

Junior Parliament is run by young people for young people. It’s a chance for you to BE THE CHANGE on the issues you care about, meet some new friends & develop your leadership skills.

If you want to be part of this incredible experience, apply to be a Junior Parliamentarian today!

WHO CAN APPLY?
Junior Parliament is open to anyone in South Australia aged 12-15 years old.

**KEY DATES**
Junior Parliament will be held in the first week of the October school holidays.
29th September - 1st October 2025 (Monday-Wednesday).

COST:
There is a participant fee of $300 per person which covers meals, accommodation and transport during the program.

TO APPLY:
Please click NEXT and fill in the following questions. It should take 10-15 minutes to complete.
Please Note: To complete the form, you will need your Medicare details (if applicable).

Applications close:
Sunday 31st August 2025

All applicants will be notified of the outcome of their application via email within 14 days of Applications closing.

QUESTIONS?
Email us at youthparliament@ymcasa.org.au.
I have read the Junior Parliament Overview and understand the commitments and responsibilities involved.*

Applicant Details
Full Name (e.g. John Smith)*

First NameLast Name
Date of Birth*

DayMonthYear
Preferred Pronouns (e.g. he/him, she/her, they/them)
Current age*
Age as of 31st September 2025*
Gender*
If gender option not listed, please type here
Applicant Phone Number*
Applicant E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which school/training organisation do you attend?*
**Please Note: Applicants under the age of 18 require parental/caregiver consent to participate.**
Parent / Guardian Name (if under 18)*

First NameLast Name
Parent / Guardian phone number (if under 18)*
Parent / Guardian email contact (if under 18)*

Emergency Contact Details
Emergency Contact Person #1*

First NameLast Name
Relationship to Applicant*
Mobile Number*
Phone Number
Other Phone Number
Phone Number
Email*
example@example.com
Emergency Contact Person #2*

First NameLast Name
Relationship to Applicant*
Mobile Number*
Phone Number
Other Phone Number
Phone Number
Email*
example@example.com
Emergency Contact Person #3 (Optional)

First NameLast Name
Relationship to Applicant
Mobile Number
Phone Number
Other Phone Number
Phone Number
Email
example@example.com

Medical Details
Medicare Number
Number Next to Applicant Name
Expiry Date (MM/YY)
Do you have Ambulance Cover?

YesNo
If you have Private Health Insurance, can you please provide the number and expiry date.
Are there any other details about the applicant we should be aware of?
I give permission for my child/ participant to be given the following (Please select any you are comfortable with YMCA staff members providing)

ibuprofen (Nurofen)Paracetomol (Panadol)Antihistamine (Claryntine)

Image Consent, Application Permission and Important Information

To be completed by the applicant or parent/guardian if under 18.
YMCA South Australia - IMAGE CONSENT

I give YMCA South Australia the irrevocable right to use my name/photograph/ image/audio recording/video recording and likeness in all forms and manner (“My Image”) for the purposes of advertising, media publicity, publication, general display or for any other organisation purposes in whole or in part, including but not limited to publication on internet web sites, broadcasts and any other publications as released to or by YMCA South Australia.

I waive any interest that I may have in the copyright to My Image now or at any future time and acknowledge that I am not entitled, nor shall in the future be entitled, to receive any payment or consideration in respect of it and agree to make no claim against YMCA South Australia for any payments for the Publication of My Image.

I understand YMCA South Australia cannot control unauthorised use of My Image by persons not associated with YMCA South Australia upon the Publication of My Image. I release and indemnify YMCA South Australia from any loss, damage, costs, expense, or claim (including consequential loss) connected with the Publication of My Image, including action for defamation, libelous material, breach of privacy, or copyright.

If under the age of 18, image consent must be granted by a parent or legal guardian.
I have read, understand and agree to the above Image Consent*

YesNo
Full name of person providing consent (must be over the age of 18)*
ACKNOWLEDGEMENT AND CONSENT

I hereby give full consent to the applicant listed in this form to participate in the YMCA South Australia Junior Parliament program. I understand that this involves attending three (3) day residential camp, participating in some physical activity, travelling to various venues in a hired bus and potentially attending Parliament House in Adelaide.

I acknowledge that successful applicants well be sent a Code of Conduct and permission form for the Junior Parliament program to be signed by a parent or guardian.

I acknowledge that there is a program fee of $300 per person to participate in Junior Parliament. I understand that the fee covers program costs such as parliamentary training, recreation activities, residential camp accommodation, transport and meals. I understand that program fees can be covered by seeking external sponsorship.
I acknowledge the details in this application are true and accurate at time of submission. I wish to be considered for Junior Parliament 2025.*

Yes
I understand that there is a $300 participation fee for Junior Parliament. I understand it is my responsibility to either find a sponsor or pay the fee myself.*

Yes
Youth Empowerment Terms and Conditions
Should be Empty:

Participant Application Form

Applicant Details

Emergency Contact Details

All About The Applicant

Applying for Junior Parliament 2025

Experience/Background

Medical and Health Details

Medical Details

Image Consent, Application Permission and Important Information