Leopold Youth Activities

The Youth Development Unit will be running some more activities for young people in Leopold, but need your help to decide which ones.
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If you would like to receive information about events for young people in Leopold, fill in your details below:
	Given Name:
	Surname:
	Address:
	Suburb:
	Post Code:
	Day Phone:
	Mobile Phone:
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Activities - Please tick the activities you would like to be involved in, or tell us some that we haven't thought of.
	Ice Skating	Movie night in Geelong
	Ten Pin Bowling	Movie night at the LINC
	Galactic Circus	Vic Market, Melbourne
	Computer gaming days	Sports games
	Horse riding	Learn to surf lessons
	Parkour	Imax Theatre
	Melbourne Aquarium	Rialto Tower / Day in Melbourne
	Luna Park	Werribee Zoo
	Rides and games at the LINC	Trip to the beach
	Adventure Park	Mini Golf
	Band night at the LINC	Disco at the LINC
	Laser Skirmish	Arts / theatre activities

	Other (Please list):


Declaration
I declare that the information provided in this form is true and correct. The personal information being collected on this form is for council purposes which will be solely used for this primary purpose or directly related purposes. In addition, the informant understands that they may apply to council for access and/or amendment of the information. This information will not be disclosed except as required by law.
YES