Crèche Enrolment Form » Port Hedland Leisure

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Parent/Guardian Details
Children Details
Emergency Contact Details
Parent Statement
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Parent/Guardian Details

Membership Number

First Name*

Last Name*

Street Address:*

City:*

State:*

Post Code:*

Country:*

Email*

Date of Birth*

Mobile*

Second Parent/Guardian's Details

Please enter details for the second parent/guardian below

Membership Number

First Name

Last Name

Street Address:*

City:*

State:*

Post Code:*

Country:

Date of Birth

Mobile

Children Details

First Name*

Last Name*

Platinum Family Nomination

YesNo

Date of Birth*

Gender*

Are there any important medical or physical conditions about your child we should be aware of?*

YesNo

Max File Size: 100.00 MB
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First Name

Last Name

Platinum Family Nomination

YesNo

Date of Birth

Gender

Are there any important medical or physical conditions about your child we should be aware of?

YesNo

Max File Size: 100.00 MB
Allowed File Types: .doc, .docx, .jpeg, .jpg, .pdf, .png

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Emergency Contact Details

Please provide a contact in addition to the child's Parents/Guardians

First Name*

Last Name*

Relationship to Child*

Mobile*

Street Address:*

City:*

State:*

Post Code:*

Country:*

Parent Statement

I confirm that:

I have read and agree to the provisions detailed in the Crèche Parenting Handbook.
I must stay within the facility (inside the building) while my child/children attend the crèche.
My child/children can attend programs on the indoor courts in Wanangkura Stadium (Kiddo, Playgroup Sessions, etc.).
Photos may be taken of my child/children whilst participating in activities, and I agree to the photos being used as described in the Crèche Parenting Handbook.
I have discussed the immunisation status of my child/children on enrolment.
Only the adults listed above have approval to collect my child/children.
Only children ages 8 weeks – 11 years of age are permitted entry into the crèche.
I am allowing authorisation for the drop off and/or collection of my child/children to those stated above.
I will not bring my child/children to the crèche if they are unwell.
This is an allergy-aware facility, and I will not bring nuts into the centre or any other foods as described in the Crèche Parenting Handbook.
I am responsible, at all times, for my child/children while they attend the crèche.
I must immediately return to the crèche area to attend to my child/children should I be requested.
I will not be late to collect my child/children from the crèche, and a fine may apply.
My child/children are recommended to be immunised before using crèche facilities.
I authorise the obtaining of medical or hospital treatment for my child/children as required and agree to cover any related expenses.
In case of emergency, I consent to my child/children being transported by ambulance. I understand I will be consulted where possible.
I understand that information provided in this form will be accessible to staff; utilised for the purposes of registration, the provision of crèche services, and/or closely related purposes; and will be managed in consistency with the Town of Port Hedland's Privacy Policy, and the Privacy and Responsible Information Sharing Act 2024. For enquiries, access or information correction, please email: leisure@porthedland.wa.gov.au

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Parent/Guardian Details

Children Details

Emergency Contact Details

Parent Statement

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