Connect and Thrive, Tamworth - Registration Form

Young Person Registration Form - Connect and Thrive Pathways

Tuesday 16 September 2025 | Tamworth Regional Youth Centre | Tamworth
About you
Name

First NameLast Name
Age
If under 18, you will be asked to include your parent's information
Email
What suburb or town do you live in?
Which of the following best describes your gender?

Other
Your Pronouns are?

Other
Phone Number
Is your emergency contact the same as your parent/guardian?
Emergency Contact

First NameLast Name
Emergency Contact Email
Emergency Contact Number
Parent/Guardian's Name

First NameLast Name
Parent/Guardian's Email
Parent/Guardian's Phone Number
Do you identify with any of the following? (Tick all that apply to you)
How did you hear about this event?
What is the name of your Youth Provider?
Headspace, Local Youth Space etc.
What is the name of the Community Member?
Not a mandatory field
What is the name of the Elder?
Not a mandatory field
If you selected 'Other', please write it here.
Please select all that apply to you.

Other
If you selected 'I attend school', please type in your full school name
If you selected that you have a job, please tell us the industry you work in.
(If known)
What industries in your local community would you be interested in learning more about?

Other
What do you feel are the top three issues facing young people?
Do you have any dietary requirements? If so, please list them here.
Do you require any additional support or adjustments for this event?
Please tell us about the adjustments needed here. If required, please provide the full name of your support worker or carer and their contact number.
Is there anything else you would like us to know to help you participate in the event?
Should be Empty:

Young Person Registration Form - Connect and Thrive Pathways

About you