Registration

This information is required for Playgroup WA Insurance and will only be disclosed to the Jarrahdale Playgroup president and Playgroup WA.

Once this form is processed you will receive an email to the address provided with payment options and another with session information. If you would prefer to pay with cash you may do so at your next session.

Please note that the Jarrahdale Playgroup Annual Membership is per family and includes access to unlimited sessions.

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Parent Name

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

Parent Gender(required)

Male

Female

Intersex / Indeterminate

Not Stated / Inadequately Described

Phone Number

Address

Parent country of birth

I (Parent) am an….(required)

Australian Permanent Resident

Australian Citizen

Neither

I (Parent) am an…(required)

Aboriginal Australian

Torres Strait Islander

Other Indigenous Status

None of the above

Parent language spoken at home (Including AUSLAN)

How did you hear about us?

Child #1 Name

Child #1 D.O.B (YYYY-MM-DD)

Child #1 Gender(required)

Male

Female

Intersex / Indeterminate

Not Stated / Inadequately Described

Child #1 Country of Birth

I (Child #1) am an…(required)

Aboriginal Australian

Torres Strait Islander

Other Indigenous Status

None of the above

Child #1 Disability, Impairment or condition(required)

Child #2 Name

Child #2 D.O.B (YYYY-MM-DD)

Child #2 Gender

Male

Female

Intersex / Indeterminate

Not Stated / Inadequately Described

Child #2 Country of Birth

I (Child #2) am an…

Aboriginal Australian

Torres Strait Islander

Other Indigenous Status

None of the above

Child #2 Disability, Impairment or condition

Child #3 Name

Child #3 D.O.B (YYYY-MM-DD)

Child #3 Gender

Male

Female

Intersex / Indeterminate

Not Stated / Inadequately Described

Child #3 Country of Birth

I (Child #3) am an…

Aboriginal Australian

Torres Strait Islander

Other Indigenous Status

None of the above

Child #3 Disability, Impairment or condition

Child #4 Name

Child #4 D.O.B (YYYY-MM-DD)

Child #4 Gender

Male

Female

Intersex / Indeterminate

Not Stated / Inadequately Described

Child #4 Country of Birth

I (Child #4) am an…

Aboriginal Australian

Torres Strait Islander

Other Indigenous Status

None of the above

Child #4 Disability, Impairment or condition

Child #5 Name

Child #5 D.O.B (YYYY-MM-DD)

Child #5 Gender

Male

Female

Intersex / Indeterminate

Not Stated / Inadequately Described

Child #5 Country of Birth

I (Child #5) am an…

Aboriginal Australian

Torres Strait Islander

Other Indigenous Status

None of the above

Child #5 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 (0-5years)

Fathers Group (0-5years Male carers only)

Jarrahdale Wildschool (0-15years, homeschoolers only)

I will be paying:(required)

Casually (On the day)

Per term (Discounted rate)

Jarrahdale Playgroup Annual Membership (Per Family) ($250/year)

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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