Online Form - Youth Advisory Group Application Form

Your commitment to YAG:

The YAG will meet monthly at the Eaton Shire Council Chambers, the option to Zoom into the meeting is available for all members.

Additional meetings may be organised and have the potential to be hosted in Burekup, Dardanup or Eaton at the discretion of the Place and Community Officer with the agreement of the members of YAG.

Communication is key with this group. It is the YAG members responsibility to keep in touch with the team via the required communication tools, such as text and email.

Each YAG member will be required to take part in a minimum of six meetings per year, unless an alternative has been discussed with the Place and Community Officer.

If you have any queries or want to talk through the process, please do not hesitate to contact the team on events@dardanup.wa.gov.au or on 9724 0392

Introduction

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Name*

Pronouns*

Date of Birth*

Age*

Contact Phone Number*

Address

Street Address:

City:

State:

Post Code:

Country:

Email*

Cultural Identity

What are some of the strengths you feel you could bring to YAG?*

What do you hope to gain from being involved in the YAG?*

Medical Information: Please list any known allergies or other medical conditions that we may need to be aware of. Please provide additional information if you potential require treatment, i.e. to administer ventolin or an epi-pen*

I declare that I am between 12 and 24 years of age and agree to Youth Advisory Group expectations listed on the website*

YesNoUndecided

Parent/ Guardian Name*

Parent/Guardian Contact Phone Number*

Parent/Guardian Email Address*

Additional Emergency Contact Name (different from above)*

Additional Emergency Contact Phone Number*

Parent/Guardian: I give permission for this YAG applicant to make their way to and from YAG meetings, events and activities. I will contact the Shire of Dardanup if this changes*

Parent/Guardian: I give consent for images taken of the YAG applicant/member to be used by the Shire of Dardanup and authorised third parties for promotional purposes.*

Parent/Guardian by selecting yes you give consent for the applicant to participate in the Shire of Dardanup Youth Advisory Group*

YesNoUndecided

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Online Form - Youth Advisory Group Application Form

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