Online Form - Registration Form

Details

Guardians Name *

Email *

Phone Number

Children Names

Child 1 Name: *

Date of Birth *

Child 2 Name (if applicable):

Date of Birth

Child 3 Name (if applicable):

Date of Birth

Child 4 Name (if applicable):

Date of Birth

Emergency Contact Details

Name *

Phone Number *

Address

Street Address:

City:

State:

Post Code:

Country:

I agree

By checking the box, I confirm that my children are between the ages of 13-17 and I give consent for them to attend the GRAMS NAIDOC Youth Ball. I understand and acknowledge the nature of the event and that appropriate supervision will be provided.

I agree

By checking the box, I give permission for GRAMS to take photographs or videos of my children during the GRAMS NAIDOC Youth Ball on Friday 7 July. Any photos or videos taken may be used by GRAMS for educational and promotional materials. These photos and videos may be used on GRAMS website and social media platforms.

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Online Form - Registration Form

Details

Children Names

Emergency Contact Details

Geraldton Regional Aboriginal Medical Service

Carnarvon Gascoyne Outreach Service

Murchison Outreach Service