YAGS Application Form

YAGS Application Form

Youth Advisory Greater Springfield
Personal Details
Name

First NameLast Name
Pronouns

Other
Nationality
School, Learning Institution
DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Parent Guardian Consent
Parent Guardian Name

First NameLast Name
Relationship to applicant
By ticking this box, I confirm that I am under 16 years of age and have parental consent to submit an application to participate in Youth Advisory Greater Springfield (YAGS
I agree
Parent Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Contact details
Address

Street Address

Street Address Line 2

SuburbState / Province

Postal / Zip Code
Email
example@example.com
Phone
Preferred Contact Method

Emergency Contact Details
Emergency Contact Name

First NameLast Name
Emergency Contact Email
example@example.com
Emergency Contact Phone
Relationship to applicant

Supporting Information

Please provide a response to the following questions
Why do you want to join YAGS?
Tell us something you're proud of achieving, or proud of being a part of, and tell us why.
What do you think are the important issues impacting young people in your local area?

Participation Statement
By ticking this box, I confirm that I would like to participate in the Youth Advisory Greater Springfield (YAGS) and that the information provided in this application is true and correct. I have carefully read and understand the conditions of entry and am prepared to meet these conditions if selected.
I agree
Signature
Form ID
Should be Empty: