Date of Birth (required)

Gender (required)
if applicable

The personal information on this form is being collected by Wyndham City Council for the purpose of registering personal details to receive promotional material related to Youth Services. The personal information will be used by Council and its contacted service providers for that primary purpose or directly related purpose from which is stated. The applicant understands that the personal information provided is to receive promotional material related to Youth Services and shall be disclosed to Youth Services Staff to enter details into Youth Data Base and disclosed to Youth Service Staff for the purpose of mailing out these promotional material related to Youth Services., but shall otherwise remain private within Council unless disclosure is required by law. You may apply to council for access and/or amendment of the information. Request for access and/or amendment of the information should be made in writing to council’s Privacy Officer.

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