HOLY ROSARY PLAYGROUP

MEMBERSHIP FORM

Holy Rosary Playgroup | at Holy Rosary School | 35 Williamstown Road |Doubleview WA 6018 admin@hrs.wa.edu.au and (08) 9203 4500

1. The form is to be completed by the parent. 2. Make payment to Playgroup WA (details in this form). 3. Bring the completed and signed form to Playgroup. Parent Details

Full Name of Parent

Address

Suburb

Postcode

Telephone / Mobile

Email

Carer Details

Where the parent is not attending Playgroup, please provide the details of the Carer.

Full Name of Carer

Relationship to Child

Telephone / Mobile

Emergency Contact Details Please provide the details of someone not attending playgroup.

Full Name

Relationship to Child

Telephone / Mobile

HOLY ROSARY PLAYGROUP – MEMBERSHIP FORM

Child(ren’s) Details

Full Name DOB Allergies

Membership Fees 1. The fee to Playgroup WA (Inc) provides members with a number of benefits, including insurance. 2. Holy Rosary School offers its facilities free-of-charge to Holy Rosary Playgroup. 3. Each family only pays one Playgroup WA membership per year, regardless of the number of

membership playgroup attended. Please indicate with an ‘X’

$35 Family Fee $15 Health Care Card Concession $ - Paid to another playgroup this year – please provide your membership number below: EXISTING MEMBER:

Your Playgroup WA membership number is for life. If you have forgotten it, please phone Playgroup WA on 1800 171 882 to obtain it. Payment Method All fees are paid by EFT directly to Playgroup WA. Please take careful note of the reference you need to enter. Fees are payable to Playgroup WA within your third week of joining.

Account Name Playgroup WA (Inc) BSB 066 110 Account Number 0090 3806 Reference (your name prefaced by ‘HR’ for ‘Holy Rosary’)

HR [Initial] [Surname] e.g. HR J Smith

HOLY ROSARY PLAYGROUP – MEMBERSHIP FORM

Conditions of Holy Rosary Playgroup Membership 1. The Carer is not a business. 2. Parents / Carers always attend the playgroup with their child(ren). 3. Parents / Carers initial the register on arrival for the session. 4. No nuts are brought to Playgroup. 5. Playgroup WA collects information required to conduct its business. 6. Holy Rosary School collects information required to conduct its business. Publicity and Use of Images Holy Rosary School takes the upmost care to use photos and video that respect the dignity of people who feature in them. I give permission for the use of my child’s photo/video image in playgroup and school publicity activities (newsletter, Holy Rosary Facebook page and school website; and in local media publicity activities (local newspaper). Please indicate with ‘X’ if you wish to OPT OUT

OPT OUT of Publicity and Use of Images Agreement to Terms of Holy Rosary Playgroup By signing you acknowledge that you are aware of and agreeing to all the information set out on this form. Parent’s Name

Parent’s Signature

Date