Playcircle Registration

Child's Details

First Name *

Last Name *

Date of Birth *

Gender *

Address *

Suburb *

Post Code *

Languages

Allergies

Person who attends Playcircle with the child:

Parent/Carer Name: *

Parent/Carer's Mobile Number *

Parent/Carer's Email Address *

Relationship to Child *

Any Comments:

Tip: If more than one person attends Playcircle with the child, please add these details here.

Different Contact - for Emergency Use only

Emergency Contact Name: *

Emergency Contact Mobile Number *

Photo Permission

I give the following permission: Photos and Videos may be used with St Paul's Anglican programmes and services and/or advertising purposes. *

The information collected on this form will be used for the purpose of arranging this St Pauls ministry activity. It will be disclosed to St Pauls staff members and will be handled in accordance with our Privacy Policy. By completing this form, you indicate your consent for us to collect, use and disclose the information you have provided above in this manner.