Connect and Thrive, Tweed Heads

Young Person Registration Form - Connect and Thrive Pathways

26th November 2025 | Murwillumbah Civic and Cultural Centre | Auditorium
About you
Are you completing this form on behalf of a young person?
Only complete if you are a teacher or support person.

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? *
FemaleMaleNon\binaryPrefer not to sayOther
She/HerHe/HimThey/ThemPrefer not to sayOther
Phone Number *
YesNo
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*
I am a First Nations young personI speak a language other than English at home with my familyI live with a disabilityI have arrived to Australia within the last 5 years as a refugee or migrantI have had experience with the police or the justice systemI identify as LGBTQIA+I live or have lived in out of home careI am a parentI experience or have experienced povertyI experience or have experienced substance use issuesI experience or have experienced mental healthI experience or have experienced insecure housing and homelessnessI am a young carerNone of the above
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.
I attend schoolI attend TAFEI am home-schooledI have a casual jobI have a part time jobI have a full time jobI have a traineeshipI am looking for employment or studyOther
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)
RetailBeautyFast FoodHospitalityAgricultureLocal GovernmentCommunity ServicesChildcareEntertainmentHeath and FitnessHorticultureConstructionFinanceOther
Cost of livingAvailability of housingAccess to good educationBullying, including cyberbullyingUse of and impact of social media on wellbeing, mental health or identityUnemployment or access to jobsDrug and alcohol useVaping and e-cigarettesFeeling disconnected or like you don't belongManaging healthy relationshipsAccess to transportDomestic and or family violenceClimate change and environmentMental healthYoung peoples voice to GovernmentYouth crime
Do you have any dietary requirements? If so, please list them here. *
Does any young people have dietary requirements? If so, please list them here. *
YesNo
YesNo
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:

Rows	Young Persons name	Age	Has consent been given from Parent? Y or N
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Young Person Registration Form - Connect and Thrive Pathways

About you