Playgroup Registration
Family Details
Family Name
Mother's Name
Home Address
Email Address
Father's Name
Home Postcode
Mobile Number
Carer's Name (if applicable)
Phone Number
Relationship
Playgroup Children
Child's Name
Gender
Male
Female
Date of Birth
Does your child suffer from any medical conditions that we should be aware of? If yes, please specify.
Child's Name
Gender
Female
Male
Date of Birth
Does your child suffer from any medical conditions that we should be aware of? If yes, please specify.
Child's Name
Gender
Female
Male
Date of Birth
Does your child suffer from any medical conditions that we should be aware of? If yes, please specify.
Media
Would you like to be included in our Facebook Private Page?
Yes
No
Please provide Facebook name details to be added to the group
Do you consent to your child/children's photograph being used in Playgroup promotional material? (Print/digital)
Yes
No
Submit