2021 Registration Form
Prospect & Enfield Kindergym
Child #1 details
*
First Name
Last Name
Child #1 date of birth
*
/
Day
/
Month
Year
Child #2 details
First Name
Last Name
Child #2 date of birth
/
Day
/
Month
Year
Child #3 details
First Name
Last Name
Child #3 date of birth
/
Day
/
Month
Year
Is there any medical/other relevant information we need to be aware of?
Enrolling parent or caregiver name
*
First Name
Last Name
Address
*
Street Address
Suburb
State
Postcode
Phone number
*
Please enter a valid phone number.
Email (used for kindergym communication only)
*
example@example.com
Occupation (optional)
Additional caregiver details (if applicable)
PEKG is a not for profit community club managed entirely by volunteers; we are appreciative of any and all help from our members
Can we contact you about assisting the Volunteer Management Committee with activities from time to time?
Yes
No
Would you be interested in joining our Volunteer Management Committee?
Yes
No
The below questions are on a voluntary basis and are collected for information purposes only:
Are you or your child of Aboriginal and/or Torres Strait Islander origin?
Yes
Are you or your child a new immigrant or refugee?
Yes
Do you or your child have a disability?
Yes
How did you hear about us?
Submit
Should be Empty: