Enrolment – PlayAble

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Enrolment

Please complete the form below to enrol in PlayAble.

Parent/Carer
New member?*
- Yes
- No
Membership Number
Relationship to child/ren*
- Parent
- Carer
- Grandparent
Name*
Prefix First Last
Address*
Street Address Address Line 2 City State Postcode
Email*
Date*
Date Format: DD slash MM slash YYYY
Language spoken at home
Country of Birth
Child/ren
Please add your child(ren)'s details
Configuration Required
Use the Nested Form and Summary Fields settings to choose the form and fields to display in this Nested Form field.
Emergency Contact
Name
Relationship
Address same as above?
- Yes
- No
Address
Street Address City State Postcode
Mobile
Work Phone
Home Phone
Email
Consent
Do you consent to future contact and to participate in research and evaluation?
- I consent
Do you consent to provide details to government departments?
- I consent
Personal information collected on this form will be used by Playgroup Queensland as it relates directly to the programs and services we provide to you and it is required by law. Your personal information will be handled in accordance with The Privacy Act (1988) (Cth), Australian Privacy Principles. Our Privacy Policy is available at playgroupqld.com.au, or you can contact us for more information at info@playgroupqld.com.au or by calling 1800 171 882.

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Parent Account*
Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Gender*
Identify as*
- Aboriginal
- Torres Strait Islander
- Both Aboriginal and Torres Strait
- Pacific Islander
- None of the above
- Prefer not to say
Disability
- No Disability
- Psychiatric
- Sensory/speech
- Physical/diverse
- Intellectual/learning
Tick all that apply
Relationship to child*