Intergen: Member Registration EOI

Intergenerational Playgroup - Expression of Interest

Thank you for your interest in participating in Playgroup NSW Timeless Play - Intergenerational Program.

Please complete the Expression of Interest form below and one of our staff will contact you with the next steps.

In order to participate in our programs you will need to be a member of Playgroup NSW. If you are not currently a member please join online via www.playgroupnsw.org.au

Secret Field

Program Type

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Contact Details

Preferred Location *

Playgroup Record Id

First Name *

Last Name *

Gender *

Email *

Contact Number *

Mailing Address *

Street Address *

City *

State *

Postcode *

Details of Children

1. Child's First Name *

Child's Last Name *

Birthdate *

How is this child related to you? *

2. Child's First Name *

Child's Last Name *

Birthdate *

How is this child related to you? *

3. Child's First Name *

Child's Last Name *

Birthdate *

How is this child related to you? *

4. Child's First Name *

Child's Last Name *

Birthdate *

How is this child related to you? *

5. Child's First Name *

Child's Last Name *

Birthdate *

How is this child related to you? *

Additional needs of yourself and/or your child. *

Consent

At present, restrictions to enter the Aged Care residence have been relaxed. However, in order to ensure the residents are as protected as possible, do you agree that you may need to show COVID 19 vaccination to participate *

Yes, I agreeNo, I do not agree

Do you agree each week you will also check into the aged care residence as part of their Health and safety policy. *

Yes, I agreeNo, I do not agree

Comments

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Form Category

RecordType ID

Link to Form Id (Forms Hub)