Grasshoppers Playgroup Enrolment Form

Name of parent or carer attending

Mobile

Email

Address

Relationship to child(ren)

Which session are you interested in?

Monday 9:30am - 11:30am

Thursday 9:30am - 11:30am

Both Days

Child 1

Name

Birthday

Any known allergies?

Child 2

Name

Birthday

Any known allergies?

Child 3

Name

Birthday

Any known allergies?

Emergency Contact Details

Emergency Contact #1

Name

Phone

Relationship to child

Emergency Contact #2

Name

Number

Relationship to child

Playgroup Victoria Membership Number

**PLEASE COMPLETE THIS SECTION IN PERSON AT YOUR NEXT SESSION**

I being
the Parent/guardian of the above named child/ren, do hereby agree that if any
of my family is involved in an emergency situation, I accept the Group Leader’s
discretion to act on our behalf and that I will be responsible for any medical
or ambulance costs arising from such an action. I declare that I wish to become
a member of Grasshoppers playgroup, support the purposes of Grasshoppers; and
will comply with the rules set out by Grasshoppers playgroup Inc. constitution.

Signature:

Date: /
/