Intergenerational Playgroup Affiliation Form

Organisation Details

Your Organisation Name *

ABN Number *

Organisation Address *

Street address *

City *

State *

Postcode *

Your Contact Details

First Name *

Last Name *

Your Membership Number *

Role *

Intergenerational Facility Lead (Lifestyle Coordinator)Intergenerational Facility Support (Lifestyle Assistant)

Email *

Mobile *

Which form of contact do you wish to have for enquiries? *

EmailPhoneBoth

Additional Contact Details

First Name *

Last Name *

Membership Number *

Role

Email *

Mobile *

Do you want to add another Intergenerational Facility Contact? *

YesNo

Intergenerational Facility Support (3rd Person)

First Name *

Last Name *

Membership Number *

Email *

Mobile *

Role

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.

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.

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 start time using the format HH:MM AM/PM (example: 12:00 PM).

Session Frequency *

Session Frequency (Other) *

Age Group *

Language *Language the session is run in

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

Yes, I agreeNo, I do not agree

As representatives of this group, I agree to abide by Playgroup NSW's Code of Conduct. *

Yes, I agreeNo, I do not agree

Source

Form Category

RecordType ID

Link to Form Id (Forms Hub)

Contact Details

Intergenerational Playgroup Affiliation Form

Organisation Details

Your Contact Details

Additional Contact Details

Intergenerational Facility Support (3rd Person)

Playgroup Details & Submit Form

Playgroup Details

Playgroup Session Details