Brookes Street Nambour Community Kindergarten
Pre-Prep Playgroup registration form
Childs Name:
*
First Name
Last Name
D.O.B
-
Day
-
Month
Year
Date
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Information
Name
*
First Name
Last Name
Relationship to child:
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Emergency Contact
Name
*
First Name
Last Name
Relationship to child:
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
General Information
Does your child have any dietary requirements we should be aware of? Please provide details below
We would love to hear about your child’s interests and the activities they enjoy, to help us get to know them better as part of our playgroup community.
Are there any dislikes, triggers, or sensitivities your child has that we should be aware of to help support their comfort and wellbeing during playgroup?
What are you hoping your child and family will experience by being part of our Pre-Kindy Playgroup community?
Medical Information
Does you child have any allergies or medical conditions?
*
Yes
No
If yes, please specify:
Does your child have any additional needs, diagnosed or undiagnosed, that we should be aware of to support their participation in playgroup?
*
Yes
No
If yes, please specify:
Permissions
I give permission for my child to use service Sunscreen and Repellent.
*
Yes
No
I give permission for my child to be administered first aid if necessary during the playgroup session.
*
Yes
No
I give permission for photos of my child to be taken and used within the service at Brookes Street Kindergarten.
*
Yes
No
I give permission for photos of my child to be used by Brookes Street Kindergarten on their Facebook and Website.
*
Yes
No
I give permission for photos of my child to be shared by Brookes Street Kindergarten on their closed Pre-Kindy Playgroup facebook page.
*
Yes
No
I would you like to receive an invitation to join the closed Facebook group for playgroup families?
*
Yes
No
I understand that while staff from Brookes Street Kindergarten will be present during playgroup sessions, I remain responsible for the supervision and care of my child/ren at all times.
*
Yes
No
Full Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Signature
Continue
Continue
Should be Empty: