2025 Playgroup Registration Term 4

Please Choose a Desired Session Time *

10:30am-12:00pm Friday

Name of Child 1 *

Gender

Male

Female

Child 1 Preferred Pronouns

Child 1 Date of Birth *

Child 1 Allergies or Health Conditions? *

(If bringing a second child) Child 2: Name

Child 2: Gender

gender.male

gender.female

Child 2: Preferred Pronouns

Child 2: Date of Birth

Child 2 Allergies or Health Conditions?

Parent 1: Name *

Parent 1: Relationship to Child *

Parent 1: Date of Birth *

Gender and Preferred Pronouns *

Parent 1: Mobile Phone *

Parent 1: Email *

Parent 1: Home Address *

manageMemberFields.fields.AddressLine

common.city

common.area

manageMemberFields.fields.postalCode

Parent 2: Name

Parent 2: Relationship to Child

Gender and Preferred Pronouns

Parent 2: Date of Birth

Parent 2: Mobile Number

Parent 2: Email

Parent 2: Home Address (if different from above)

Will You have Another Adult Accompanying your Child to Playgroup? *

Yes

(If needed) Please Write Accompanying Adult's Name and Contact Information HERE (name, mobile, email, postcode):

Emergency Contact Name/s and Relationship *

Emergency Contact Mobile Number *

Emergency Contact Email Address *

Emergency Home Address

Emergency Contacts are Authorised to be Notified of an Emergency, If I Cannot Be Contacted *

Yes, I authorise

No, I do not authorise

Is there anything else we need to know? *

I (Parent/Guardian) consent to recognisable photographs and/or video footage of my child being used in the following manner: *

displayed on public noticeboards within St James' church building

for St James' 'in-house' publicity, activites or worship gatherings - including printed and projected images

in printed material for use external to St James (for example n welcome packs or publicity brochures)

on St James church website

on St James social media

I do not wish recogniseable photographs or video footage of my child to be used by St James in any context*

Signature *common.clear

Date *

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