Application to enrol - Playgroup
Attending child's name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Gender
*
Additional child attending name
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Gender
Person attending with child/ren
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Email
*
example@example.com
Person responsible for account
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Post Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Emergency Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Relationship to you
Which session would you like to attend
*
Please Select
Monday (Terms 2-4) 9:30am - 11:30am
Tuesday 9:30am - 11:30am
Wednesday 9:30am - 11:30am
Thursday 9:30am - 11:30am
If a spot is not available is there another session you would like to join?
*
Monday (Terms 2, 3 and 4)
Tuesday
Wednesday
Thursday
Friday
No, I'd like to go on the waitlist.
If a spot is available, when would you like to start?
Do you have any medical issues we need to be aware of?
The Playgroup currently is using WhatsApp as a communication platform, would you like to be added to this? You will still receive communication emails from the Playgroup leader.
Yes
No
Signature of person attending
*
Signature of person responsible for account.
*
I agree to be responsible for the payment of all fees and charges when due.
Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Submit
Submit
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