Playgroup Registration Form

Child's Name (1)*

First NameLast Name

Birth Date*

MonthDayYear

Does your child have any medical or behavioral concerns, allergies or food sensitivities? Please include symptoms that may occur and required medications where relevant.*

Child's Name (2)

First NameLast Name

Birth Date

MonthDayYear

Does your child have any medical or behavioral concerns, allergies or food sensitivities? Please include symptoms that may occur and required medications where relevant.

Parent's Name*

First NameLast Name

E-mail*

Phone Number*

Parent's Name

First NameLast Name

E-mail

example@example.com

Phone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeAustralia

Enrolment for *

Do you give permission for your child/children's photograph to be used in the Centre's newsletter and/or playgroup advertising materials. You can find more information about consent and sharing photos and videos here: https://www.esafety.gov.au/young-people/consent-sharing-photos-videos. *

YesNo

Would you like to receive the Centre's newsletter, and updates on our programs & events? .

YesNo

Do you confirm you have read our playgroup policy on our website? *

YesNo

To Find out more about VPCC Playgroup Policy - Click the link below.

Playgroup Policy

Would you like to receive our Monthly E-News letter to stay in the know?

YesNo

You're invited to join our WhatsApp community chat to stay up to date with all playgroup news, updates, and reminders at VPCC—just click the link to join! -

VPCC Playgroup Community Chat

Signature

By submitting this form, I confirm that I have read and agree to all terms and conditions for participating in the playgroup at VPCC

My Subscriptions*

Playgroup Term Fees($65.00AUD for each three months)

Victoria Park Community Centre Playgroup Term Fees

Playgroup Annual Fees($234.00AUD one-time payment)

Victoria Park Community Centre Playgroup Annual Fees with 10% Discount

Credit Card