Enrolment Form

Parent/Carer Information

First Name *

Last Name *

Relationship to child *

Phone Number *

Email Address

Home Suburb: *

Emergency Contact Name: *

Emergency Contact number: *

Interested in learning more about Parent support Groups

YesNo

Child Details

Childs Name: *

Date of Birth *

Preferred Name/Nickname *

Prounouns:

Which Thursday Session would you like to enroll in? *

10am - 11am 11am - 12pm

About your child

What are your child’s favourite activities/interests? *

How does your child usually communicate? *

What helps your child feel safe and comfortable? *

Are there any triggers or situations we should avoid where possible? *

What support strategies work well for your child? *

Are there any sensory sensitivities we should know about? *

Medical & Support Information

Does your child have any allergies? *

YesNo

What allergies does your child have and what are the reactions? *

Does your child require and EPI Pen? If yes, please bring a copy of their anaphylaxis plan *

Yes No

Does your child have any medical conditions we should know about? *

Does your child require mobility support or equipment? *

Are there any safety concerns or behaviours we should be aware of? *

Is there anything else you would like us to know?

Family Support Questions

What are you hoping to gain from the playgroup?

What would help your family feel welcomed and supported? *

Are there any topics or supports you would like included in future parent sessions?

Consent Forms

Attendance & Participation Consent

I understand that:

Parents/carers remain responsible for supervising their child unless otherwise arranged

Participation is voluntary

Families are encouraged to participate at their own comfort level

Parent/Carer Signature *

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Date *

Photo & Media Consent - Please select: *

YES – I give permission for photos/videos of my child/family to be used for playgroup promotion.NO – I do not give permission.

Parent/Carer Signature *

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Date *

Emergency Medical Consent

In the event of an emergency, I authorise staff/volunteers to administer first aid and seek medical assistance for my child.

Parent/Carer Signature: *

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Date: *

Privacy Statement

All information collected is kept confidential and used only to support safe participation and communication within the playgroup.

Information will not be shared outside the organisation without consent unless required by law.