THE BRIDGE - Playgroup Enrolment Form 2024 • Werribee Baptist Church

CHILD DETAILS

First Name *

Date of Birth *

Current Playgroup Session (if applicable)

Surname *

Allergies

Medical Conditions

PARENT/GUARDIAN DETAILS

Address *

Suburb

Postcode

Mother/Guardian Details

Name

Mobile Number

Email Address

Please provide at least one email address, as this will be our primary means of contact with you.

Father/Guardian Details

Name

Mobile

Email Address

Emergency Contact

Emergency Contact Name

Relationship to Child

Emergency Contact Number

ABOUT YOUR CHILD

Please tell us anything you feel we should know about your child; including but not limited to...learning difficulties, behavioural challenges, medical issues, or anything else that will best help us serve your children.

IMPORTANT TO NOTE

Privacy Statement

In accordance with the Privacy Policy of The Baptist Union of Victoria any information provided will be used only for the ministry of this church and activities related to this church. The information will not be released to any organisation outside of this church.

Photograph Disclaimer

At times we take photos and/or videos of the children, which may be used around the Playgroup Room or used to advertise Playgroup activities to the WBC congregation, or online. If you do no consent to this, please note this below.

Your acknowledgement below confirms your consent for your child's photo to be used.

Please note that completing this form does not guarantee your enrolement, please wait for confirmation from the Playgroup Coordinator before attending.

Yes ... *

I acknowledge I have read and consent to the above Important To Note section.

Notes

ELECTRONIC SIGNATURE

I (Enter name of Parent/Guardian)

I have completed the above application form, with the understanding that our child will be considered for enrolment in the 2023 Playgroup Sessions, pending confirmation by the Playgroup Coordinator