Crèche Enrolment Form

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Parent/Guardian Details
Children Details
Emergency Contact Details
Disclaimer
Submit Response

Parent/Guardian Details

Membership Number

First Name*

Last Name*

Street Address:*

City:*

State:*

Post Code:*

Country:

Email*

Date of Birth*

Mobile*

Membership Number

First Name

Last Name

Street Address:

City:

State:

Post Code:

Country:

Date of Birth

Mobile

Children Details

First Name*

Last Name*

Date of Birth*

Gender*

Platinum Family Nomination*

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

Please provide more information on all conditions pertaining to your child. Additional details on required actions/measures and copies of allergy plans etc. can also be attached in the section below

Max File Size: 10.00 MB
Allowed File Types: .doc, .docx, .jpeg, .jpg, .pdf, .png

First Name

Last Name

Date of Birth

Gender

Platinum Family Nomination

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

Please provide more information on all conditions pertaining to your child. Additional details on required actions/measures and copies of allergy plans etc. can also be attached in the section below

Max File Size: 10.00 MB
Allowed File Types: .doc, .docx, .jpeg, .jpg, .pdf, .png

First Name

Last Name

Date of Birth

Gender

Platinum Family Nomination

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

Please provide more information on all conditions pertaining to your child. Additional details on required actions/measures and copies of allergy plans etc. can also be attached in the section below

Max File Size: 10.00 MB
Allowed File Types: .doc, .docx, .jpeg, .jpg, .pdf, .png

First Name

Last Name

Date of Birth

Gender

Platinum Family Nomination

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

Please provide more information on all conditions pertaining to your child. Additional details on required actions/measures and copies of allergy plans etc. can also be attached in the section below

Max File Size: 10.00 MB
Allowed File Types: .doc, .docx, .jpeg, .jpg, .pdf, .png

Add More

Emergency Contact Details

Please provide a contact in addition to the specified Parents/Guardians

First Name*

Last Name*

Relationship to Child*

Mobile*

Street Address:*

City:*

State:*

Post Code:*

Country:

Disclaimer

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

Remarks

Signature*

Checklist

Item	Date (DD/MM/YYYY)
Enrolled in PGM
Linked to Parents
Sent Notification Email w/ Handbook
Medical List Updated
Contact List Updated
Saved to Record System
Saved to PGM
Removed from Allergy List
Removed from Contact List
Records Archived

Submit Form

We look forward to welcoming you and your family to Wanangkura Stadium Crèche and thank you for choosing our services. We'll be in touch to confirm your enrolment shortly.

Please be reminded that bookings must be made in advance, as there are only a limited number of spots available.

Refer to the Crèche Parent Handbook on our website for more information.