About - Crèche and Kids Club Enrolment Form

Parent / Guardian Details

First Name(*)

Please let us know your name.

Last Name(*)

Please enter your suburb.

Email(*)

Please enter your email address

Address(*)

Please enter your address

Post Code(*)

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Phone(*)

Please enter your phone number.

First Name(*)

Please enter child's name

Last Name(*)

Please enter child's name

Date of Birth(*)

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Gender(*)

Male

Female

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Select the Program(*)

Does this child have asthma or any allergies for medical conditions? (*)

Yes

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Please provide details of any additional treatment this child may require or additional information you would like the City of Joondalup Leisure Centres to be aware of.(*)

Please enter child's medical conditions

Would you like to enrol a second child?(*)

Yes

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Second Child Details

First Name(*)

Please enter child's name

Last Name(*)

Please enter child's name

Date of Birth(*)

Invalid Input

Gender(*)

Male

Female

Invalid Input

Select the Program(*)

Does this child have asthma or any allergies for medical conditions? (*)

Yes

Invalid Input

Please provide details of any additional treatment this child may require or additional information you would like the City of Joondalup Leisure Centres to be aware of.(*)

Please enter child's medical conditions

Would you like to enrol a third child?(*)

Yes

Invalid Input

First Name(*)

Please enter child's name

Last Name(*)

Please enter child's name

Date of Birth(*)

Invalid Input

Gender(*)

Male

Female

Invalid Input

Select the Program(*)

Does this child have asthma or any allergies for medical conditions? (*)

Yes

Invalid Input

Please provide details of any additional treatment this child may require or additional information you would like the City of Joondalup Leisure Centres to be aware of.(*)

Please enter child's medical conditions

Emergency Contact Details

First Name(*)

Please enter your emergency contact

Last Name(*)

Please enter your emergency relation

Phone(*)

Please enter your emergency relation phone number

Please outline the name(s) of any authorised person to collect your child(ren).

Parent Declaration
I understand the Conditions of Use of the Crèche and Kids Club, as outlined in the Crèche Information document located at joondalup-leisure.com.au. City of Joondalup staff will make every effort to ensure that the highest standards of care are offered to the children enrolled in each program and I agree for my child to participate in all activities offered. The City of Joondalup will not be liable for loss, damage or injury to property or person, occasioned as a consequence of the enrolment of any child or children in the City of Joondalup Leisure Centres crèche or Kids Club program or their participation in that program. I acknowledge the exclusion of liability.

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Crèche and Kids Club Enrolment Form

Parent / Guardian Details

Child Details

Select the Program(*)

Second Child Details

Select the Program(*)

Third Child Details

Select the Program(*)

Emergency Contact Details

Please outline the name(s) of any authorised person to collect your child(ren).

Website Feedback

Parent / Guardian Details

Child Details

Select the Program(*)

Second Child Details

Select the Program(*)

Third Child Details

Select the Program(*)

Emergency Contact Details

Please outline the name(s) of any authorised person to collect your child(ren).

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