YCC Registration-2

Young Carers Connect - Registration

First Name *

Last Name *

Date of birth *

Address (including state) *

Contact Phone Number *

Email Address *

Gender Identity *

Pronouns *

Are you Aboriginal or Torres Strait Islander? *

YesNoBoth

What's your Country of Birth? *

What's the main language spoken at home?

What's your ancestry?

PARENT/GUARDIAN

Future contact will be made with a parent or guardian to introduce family workers and receive consent to attend sessions (under 16 only)

I understand the parent/guardian specified below will be contacted for an introductory chat and to gain consent.

Parent/Guardian Contact Name

Relationship to young person

Parent/Guardian Contact Number

For further enquiries please contact youngcarers@racr.org.au