Membership Application Form
Membership Type
Family Membership - $135
Family Member Concession - $85 (Concession card must be provided upon request)
Family Membership - Committee Member - $0 (must be Elected Committee Member)
Preferred Session
(i.e. Monday 11am-1pm)
Parent Name
*
First Name
Last Name
E-mail
PlaygroupWA Family ID (if known)
Address
Street Address
Street Address Line 2
Suburb
State
Post Code
Phone Number
-
Area Code
Phone Number
Country of Birth
(Required info by PlaygroupWA)
Main language spoken at home
(Required info by PlaygroupWA)
Indigenous status
(Required info by PlaygroupWA)
Disability, impairment or allergies?
(Required info by PlaygroupWA)
Do you agree to comply with the Earlybirds Playgroup immunisation policy (refer website)?
(Required info by PlaygroupWA)
Child No. 1 Name
(Required info by PlaygroupWA)
Child No. 1 Date of Birth
(Required info by PlaygroupWA)
Child No. 2 Name
(Required info by PlaygroupWA)
Child No. 2 Date of Birth
(Required info by PlaygroupWA)
Child No. 3 Name
(Required info by PlaygroupWA)
Child No. 3 Date of Birth
(Required info by PlaygroupWA)
Child No. 4 Name
(Required info by PlaygroupWA)
Child No. 4 Date of Birth
(Required info by PlaygroupWA)
My Products
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Family Membership
$
135.00
AUD
(Includes PlaygroupWA membership fee of $35)
Family Membership (Concession)
$
85.00
AUD
(Valid Concession Card must be presented upon request)
Family Membership (Committee Memeber)
$
Free
AUD
(Must be an appointed committee member for 2021)
Total
$
0.00
AUD
Credit Card
Submit Application!
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