Membership Application Form 2025
Annual Membership Feb 1 2025 to Jan 31st 2026
Annual Membership Type
Family Membership - $135
Family Member Concession Card Holders - $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
*
example@example.com
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)
If you have you already paid your PGWA Fee for 2024 with another playgroup enter your registration number here.
If you have paid the Playgroup WA fee already for 2024 with another playgroup. Please use coupon code : PGWA24 for standard family membership or concession card holders use PGWA24CC . Please provide your registration number if known.
Child No. 4 Date of Birth
(Required info by PlaygroupWA)
Annual Membership Payment Form
*
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Family Membership until Jan 31st 2026- $135
$
135
AUD
Family Membership - fee $135 ($35 Playgroup WA fee is no longer paid to Earlybirds. They will be in touch for payment.)
Family Member Concession Card Holders
$
85
AUD
Family Member Concession - $85 (Concession card must be provided upon request) The $35 Playgroup WA fee is no longer paid to Earlybirds. They will be in touch for payment.
Family Membership - Committee Member - $0 (must be Elected Committee Member)
$
Free
AUD
Family Membership - Committee Member - $0 (must be Elected Committee Member)
Enter coupon
Apply
Total
$
0.00
AUD
Credit Card
Save
Submit Application!
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