Playgroup Affiliation Form

Thank you for your interest in starting a playgroup! Please complete this form to apply for affiliation of a new playgroup. This form should be filled out by the volunteer or representative responsible for setting up the playgroup. Ensure all required fields are completed accurately, as this information will be used to register and support your playgroup.

Playgroup Details

Playgroup Name *Please use suburb in naming convention i.e. Summer Hill Munchkins

What is the expected start date of your playgroup? *

Session Fee *Please enter the session fee if families are required to pay to attend the playgroup. If the playgroup is free, please enter 0.

Session Fee Frequency *Please specify how often it is charged (e.g. $5 per session, $20 per term)

Session Fee Frequency (Other) *Please provide details on how the fee is charged.

Description of the Playgroup *Enter a brief description of the playgroup, explaining what families can expect at the playgroup, activities, age groups, or any special features. This information will appear on the website.

Playgroup Venue Detail

Name of Venue *

Is there an outdoor play area at the venue? *

YesNo

Select “Yes” if the venue has an outdoor space that children can use during playgroup sessions.

Is the venue accessible by public transport? *

YesNo

Venue Contact First Name *

Venue Contact Last Name *

Venue Contact Number *

Venue Contact Email

Venue Address *

Street address *

City *

State *

Postcode *

Playgroup Session Details

Session Day *

Session Start Date *

Session Start Time *Enter the session start time using the format HH:MM AM/PM (example: 10:00 AM).

Session End Time *Enter the session end time using the format HH:MM AM/PM (example: 12:00 PM).

Session Frequency *

Session Frequency (Other) *

Age Group *

Language *Select the language the session is delivered in.

Your Contact Details

First Name *

Last Name *

Email *

Contact Number *

Playgroup Membership Number *

Role

Are you the Main Contact for enquiries for this Playgroup? *

YesNo

Please select your preferred contact method for enquiries *

EmailPhoneBoth

Mailing Address *

Street address *

City *

State *

Postcode *

Main Contact for Playgroup Enquiry

First Name *

Last Name *

Email *The email address families can use to contact you about this playgroup.

Contact Number *

Playgroup Membership Number *

Role

Mailing Address *

Street Address *

City *

State *

Postcode *

Number of Additional Committee Members *Please enter the no. of additional committee members, excluding the main contact for enquiries.

Committee Member 1 Details

First Name *

Last Name *

Email *

Contact Number

Playgroup Membership Number *

Role

Committee Member 1 Mailing Address *

Street Address *

City *

State *

Postcode *

Committee Member 2 Details

First Name *

Last Name *

Email *

Contact Number

Playgroup Membership Number *

Role

Committee Member 2 Mailing Address *

Street Address *

City *

State *

Postcode *

Committee Member 3 Details

First Name *

Last Name *

Email *

Contact Number

Playgroup Membership Number *

Role

Committee Member 3 Mailing Address *

Street Address *

City *

State *

Postcode *

Additional Committee Member Details

First Name *

Last Name *

Email *

Contact No.

Playgroup Membership Number *

Declaration

We the undersigned, as representatives of this group of members affiliated with Playgroup NSW Inc., agree to abide by the Code of Conduct.

I agree to have these details listed on the Playgroup NSW website for enquiries about your Playgroup. *

Yes, I agreeNo, I do not agree

Submission Date

Comments (Optional)

Source

Program Name in Salesforce

Form Name

Type

Link to FormRecord Id of the Form Hub Record in Salesforce