Canning Vale Playgroup Inc
PARENT/GUARDIAN DETAILS
Attending parent/guardian surname
*
Attending parent/guardian first name
*
Attending parent/guardian contact number(s)
Attending parent/guardian email address
CHILD DETAILS
Child #1 full name
*
Child #1 gender
*
Please Select
Male
Female
Other
Child #1 date of birth
*
Child #1 allergies/medical conditions
*
(IF APPLICABLE) Child #2 full name
(IF APPLICABLE) Child #2 gender
Please Select
Male
Female
Other
(IF APPLICABLE) Child #2 date of birth
(IF APPLICABLE) Child #2 allergies/medical conditions
(IF APPLICABLE) Child #3 full name
(IF APPLICABLE) Child #3 gender
Please Select
Male
Female
Other
(IF APPLICABLE) Child #3 date of birth
(IF APPLICABLE) Child #3 allergies/medical conditions
EMERGENCY CONTACT DETAILS (NOT THE PARENT/GUARDIAN WHO WILL BE ATTENDING PLAYGROUP)
Emergency contact name
*
Emergency contact phone
*
Emergency contact relationship to child
*
Please nominate your PREFERRED day to attend a playgroup trial (we will try to accommodate where possible). ALL TIMES 9:15AM TO 11:15AM
*
Please Select
Monday preferred
Tuesday preferred
Wednesday preferred
Thursday preferred
Friday preferred
What alternate days (if any) are possible to attend a playgroup trial. ALL TIMES 9:15AM TO 11:15AM
Monday
Tuesday
Wednesday
Thursday
Friday
All children attending CVPG must be immunised or provide a Dr's letter as to why they are not.
Are children(s) immunisations up to date?
*
Please Select
Yes
No
If immunisations are not up to date please provide reason as to why (DOCUMENTARY PROOF MAY BE REQUIRED)
I have read the CVPG health guidelines (latest version on website)
*
Please Select
Yes
No
To keep up to date with news and current events, please join our Facebook page: CANNING VALE PLAYGROUP - OFFICIAL PAGE.
Enrolments Officer Email - enrolmentsCVPG@gmail.com
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