Membership Application Form 2023
Annual Membership Feb 1 2023 to Jan 31st 2024
Membership Type
Family Membership - $136 (including $35 Playgroup WA fee)
Family Member Concession - $67 (Concession card must be provided upon request, fee includes $15 Playgroup WA fee)
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)
Child No. 4 Date of Birth
(Required info by PlaygroupWA)
Have you already paid your PGWA Fee 2023 elsewhere?
If you have paid the Playgroup WA fee already for 2023 with another playgroup. Please use coupon code : PGWA23 and provide your registration number if known.
Annual Membership Payment Form
*
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Family Membership - $136 (including $35 Playgroup WA fee)
$
136
AUD
Family Membership - $170 (including $35 Playgroup WA fee)
Family Member Concession Card Holders - $67 (Fee includes $15 Playgroup WA fee)
$
67
AUD
Family Member Concession - $67 (Concession card must be provided upon request, fee includes $15 Playgroup WA fee)
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
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