Blacktown Anglican Playtime Registration Form • Blacktown Anglican Church

Playtime Registration

Is this person a Parent/Carer or a Child? *

Parent/Carer

Child

Parent/Carer Details

Child Details

First Name *

Last Name *

Mobile Number *

Email Address *

Relationship to Child *

Date of Birth *

Gender *

Allergies and Intolerances *

Yes (please give more details in box below)

Allergies and Intolerances Details

Emergency Contact Details (Someone Not Attending Playtime)

Emergency Contact Name *

Emergency Contact Mobile Number *

Emergency Contact Relationship *

Tip: What relationship is this person to the family (e.g. husband, parent, friend)

Disclaimers

Permission for Photos *

I understand that my child must be accompanied by a parent/carer at all times whilst attending Playtime: *

Yes

I understand that there is a small fee of $30 per family, per term, to attend Playtime: *

Yes

Tip: This can be paid either in person, or online. You'll be redirected to the portal for online payment after registration - click on the green 'give now' button and selct the Playtime fund.