Enrolment – Busselton Family Playgroup

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Enrolment Form

Step 1 of 4 - Membership Details

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Membership Details
Type*
- New Member
- Existing Member
Number of Child/Children to Enrol*
- One Child
- Two Children
- Three Children

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Child/Children Details
Child 1*
First Name Surname
Birthday*
Date Format: DD slash MM slash YYYY
Gender*
- Male
- Female
Child 2*
First Last
Birthday*
Date Format: DD slash MM slash YYYY
Gender*
- Male
- Female
Child 3*
First Last
Birthday*
Date Format: DD slash MM slash YYYY
Gender*
- Male
- Female

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Parent/Guardian Details
Parent/Guardian*
First Name Surname
Address*
Street Address Town / Suburb Postcode
Phone*
Email*
Are you pregnant?*
This is required for future planning to ensure we hold a place in your session for your bub when they arrive.
- Yes
- No
Expected Due Date
Date Format: DD slash MM slash YYYY
Special Needs
Should we be aware of any special needs your family may require?

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Payment Details
Which day are you enrolling for?*
Playgroup sessions are held weekly 9:00 -11:30AM
Payment Option*
- Term 4 BFPG Fees - 1 Child [Existing PGWA Member]
Payment Option*
- Term 4 BFPG Fees - 1 Child [New PGWA Member]
Payment Option*
- Term 4 BFPG Fees - 2 Children [Existing PGWA Member]
Payment Option*
- Term 4 BFPG Fees - 2 Children [New PGWA Member]
Payment Option*
- Term 4 BFPG Fees - 3 Children [Existing PGWA Member]
Payment Option*
- Term 4 BFPG Fees - 3 Children [New PGWA Member]
Total
$ 0.00
Payment Method*
- Cheque - Please make cheque payable to Busselton Family Playgroup
- Direct Debit - Please make payment to Westpac Busselton using Account Name: Busselton Family Playgroup BSB: 036-123 AC: 443623. Please include Parent Name as description.
Immunisation Certificate*
A copy of your child(ren)’s immunisation certificate(s) must be attached for your enrolment to be accepted and a position allocated. If your child(ren) are due for any immunisations between your date of enrolment and 31 December 2019, please email an updated copy of their immunisation certificate to enrolments@busseltonfamilyplaygroup.com.au
Drop files here or
Use of Photography
The Busselton Family Playgroup requests permission to take and use photographic material for promotional purposes on our website and social media accounts and occasionally in print form. Please check this box if you DO NOT AGREE with the use of photographic material of your child/ren being used in this way.
Terms*
I agree to be bound by the Rules of Busselton Family Playgroup, its policies and Charter and declare that my child(ren)'s immunisations are up to date.
Phone
This field is for validation purposes and should be left unchanged.

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