Registration Page for the Empowering YOUTH Program

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* 1. Full name of the young person who will be attending:

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* 2. Age of the young person who will be attending:

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* 3. Name and contact information of the young person's caregiver:

Name

Email Address

Phone Number

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* 4. Which Empowering YOUTH Program is the young person registering to attend:

Alice Springs:
No programs scheduled at present.

Darwin:
School Holidays 1:00 pm to 4:00 pm.
24, 25, 26 & 27 June 2024.
Crest NT, Unit 3A/66 Coonawarra Drive, Winnellie.

Palmerston:
Saturdays 2:30 pm 5:30 pm.
25 May & 1, 8 and 15 June 2024.
Community Room, Palmerston Library.

Katherine:
Saturdays 12:30 to 3:30 pm.
25 May & 1, 8 and 15 June 2024.
The Y, Henry Scott Recreation Centre.

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* 5. Please confirm that you understand that programs are delivered over multiple sessions during either the school term or school holidays:

I understand

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* 6. Please confirm that we can contact the young person and/or their authorized caregiver to discuss ways about ways to support their participation in the program:

I agree

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* 7. Please confirm that both the participant and their authorized care giver agree to this registration:

young person agrees

caregiver agrees