Existing members – Renew & Update

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Parent Name

Address

Phone Number

Other Details

Add New Child:
Child Name

Child D.O.B (YYYY-MM-DD)

Child Gender

Male

Female

Intersex / Indeterminate

Not Stated / Inadequately Described

Child Country of Birth

I (Child) am an…

Aboriginal Australian Torres Strait Islander Other Indigenous Status None of the above

Child Disability, Impairment or condition

Languages spoken at home by children (Including AUSLAN)

If one (or more) of your family have an allergy, please provide details here including name, type of allergy and treatment plan. If your situation is complex or highly serious, we will contact you to develop a plan to allow you to attend.

Which sessions will you be attending?(required)

Playgroup (0-5) Fathers Group (0-5years Males only) REGISTRATION FOR TERM 2: Musical Tots (3-5years) REGISTRATION FOR TERM 3: Pre Kindy (3years)

I will be paying:(required)

Casually (On the day)

Per term (Discounted rate)

Jarrahdale Playgroup Annual Membership (Per Child)

Type of Playgroup WA insurance required:(required)

Standard Family (1 year)

Concession Family (1 year)

Standard Family (Term 4 only)

Concession Family (Term 4 only)

I have a current Playgroup WA Membership elsewhere

I give permission for my children’s photos to be taken and understand these may be published online, in newsletters or in print.

I would like my child’s face censored in any photos published publicly

I would like to subscribe to the Playgroup Newsletter which includes details of events, excursions, activities and fundraisers (not checking this box can result in missing important updates such as time changes or closures!)

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