The Youthie School Holidays - Booking Form Below you can book single or multiple events that you wish to attend at The Youthie during the school holidays and Youth Week! Your Details Full Name* - required Street Address* - required Suburb* - required State* - required Select ACT NSW NT QLD SA TAS VIC WA Postcode* - required Phone Number* - required Date of Birth* - required Email Address* - required Do you consent to Tamworth Regional Council updating their records with the information provided above?* - required Select Yes No I agree to be responsible and conduct myself with the highest integrity whilst participating in events held at the Tamworth Regional Youth Centre. I will remain in designated areas at all times as instructed by Youth Workers.* - required Are you under 18 years of age?* - required Yes No Under 18 Parent/Guardian Full Name* - required Parent/Guardian Mobile Number* - required Photographs and/or audiovisual footage may be taken at these events. I give permission for Tamworth Regional Council to use image content of my child named above in media releases and in other forms of publicity such as websites and social meda. Please complete and submit a Media Consent and Release Authority here. I confirm a Parent/Guardian has completed the Media Consent and Release Authority form* - required Please provide details of any medical conditions, medications or dietary requirements In the event of an accident, I give permission for my child named above to be administered First Aid and to be transported to hospital by ambulance if necessary. I understand every attempt will be made to contact me before acting on this permission.* - required 18 Years Old Emergency Contact Full Name* - required Emergency Contact Mobile Number* - required Photographs and/or audiovisual footage may be taken at these events. I give permission for Tamworth Regional Council to use image content taken of me at the event in media releases and in other forms of publicity such as websites and social media. Please submit a Media Consent and Release Authority here. I confirm I have completed and submitted a Media Consent and Release Authority form.* - required Do you have a disability or medical condition? Select Yes No Disability or Medical Condition Details Please tick which options apply to you Physical Disability Hard of hearing/Deaf Low vision/Blind Neurological condition Medical condition Please provide details of your condition Please provide information on any mobility issues you may have Activities Please select the activity session/s you would like to attend: Please select the activity session/s you would like to attend* - required Tuesday 26 September 2023 - Cultural Art Workshop Wednesday 27 September 2023 - Run For Your Life Gym Thursday 28 September 2023 - Dodgeball Friday 29 September 2023 - Lake Keepit Saturday 29 September 2023 - Basketball, Oztag, Table Tennis Tuesday 3 October 2023 - Basketball, Oztag, Table Tennis Wednesday 4 October 2023 - Ten Pin Bowling Thursday 5 October 2023 - Arts and Crafts Activities Friday 6 October 2023 - Laser Tag Saturday 7 October 2023 - Kooty Pool Privacy Statement Personal information supplied to or collected by Tamworth Regional Council will only be stored and processed by Council for lawful purposes directly related to the functions and activities of Council. Any personal information supplied will only be disclosed to a third party for the purpose of performing a lawful function or activity and for no other purpose. Disclosure of personal information to a third party will be in accordance with Tamworth Regional Council's Privacy Management Plan (PDF 331.7KB). RecFullName Mandatory field(s) marked with *