Account Info Registration Date * Parents First Name * Parents Surname * Username * User Email * Password * CONTACT INFORMATION Contact Number * Home Address * Suburb * Postcode * DETAILS OF YOUR CHILD/CHILDREN All children who attend the center (including those under 6 months of age) must be listed below. Number of your child/children * Please only include children who will be attending the playgroup (i.e. 0-5 years old) Child 1 First Name * Child 1 Last Name * Child 1 Date of Birth * Child 1 Gender * MaleFemale Child 2 First Name * Child 2 Last Name * Child 2 Date of Birth * Child 2 Gender * MaleFemale Child 3 First Name * Child 3 Last Name * Child 3 Date of Birth * Child 3 Gender * MaleFemale Child 4 First Name * Child 4 Last Name * Child 4 Date of Birth * Child 4 Gender * MaleFemale Child 5 First Name * Child 5 Last Name * Child 5 Date of Birth * Child 5 Gender * MaleFemale Child 6 First Name * Child 6 Last Name * Child 6 Date of Birth * Child 6 Gender * MaleFemale Day Attending * MondayTuesdayWednesdayTuesdayFridaySaturdaySunday Session * MorningMid DayAfternoon ADDITIONAL INFORMATION The following information is required by Playgroup WA to receive Commonwealth funding. Does your family speak a language other than English? Does any family member have a disability? Does your family come from an Aboriginal or Torres Straight Islander background? Register
