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Thank you!Toddler Time 2021REGISTRTION FORM - Please complete this registration for 2021First Name*Last Name*Phone*Date of BirthRelationship to child/children*Facebook name that appears on the accountBusiness NameEmail*Address*City*State*Post Code*Which Program are you interested inPlease selectToddler Time ThursdaysChilds Name*Childs NameChilds NameChilds NameChilds DOB*Childs DOBChilds DOBChilds DOBAny allergies we need to know about?Any comments or questions you may have for us!Is your child/children up to date with immunisations?*YesNoIs it ok for us to contact and keep you updated via Email / Facebook?YesEmergency contact personEmergency contact numberRelationship to your childName of family member that may occasionally attend and family relationshipName, Address and Telephone number of family doctor (in case of emergency)Photograph PermissionI give permission for Warnbro Community and Family Centre Incorporated to take photographs of my above-named children, which may be used for promotional purposes ONLY. The photographs may be displayed at shopping centres, the newspaper, or at community events within Australia or posted on the Warnbro Community and Family Centre/Warnbro Playgroup website or Facebook page. Without this, we can not take photos of our events to promote our Community Centre.SignatureYesNoDateHow did you hear about our program or community centre?Price Guide only t&c's apply. Toddler Time Fees are paid per term.Please Select your Price - Single Child FamilySingle Child Per Term - $6pwSingle Child Per Term - $5pw Concession Single Child Casual - $7pwPlease Select your Price - Multi-Child FamilyMulti-Child Per Term - $8pwMulti-Child Per Term - $7pw ConcessionMulti-Child Casual - $9pwPlease note: paying per term guarantees you a spot each week.Payment Details - EFT OptionBank Details for EFTPlease enquire to purchase these in the centre mangers office if you do not wish to do it onlinePayment is per term in advance if you wish to pay cash please arrange this with the centre manager. You can pay by Bank Transfer (see above please use the initials 'TTSG and your name' as the reference on the bank transfer), or by credit card on the form, over the phone or at the centre.Bank DetailsPlease email a copy of your payment toCard Payment OptionCardholder NameCard NumberExpiration MonthPlease SelectJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberExpiration YearPlease Select2020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050CVCAuthorised AmountAuthorise Payment DateMake my payment re-curingWeeklyTerm BasedAny CommentsT & C'sRates are set by Warnbro Community and Family Centre, and have the right to increase rates at the beginning of any term, also has the right to refuse entry for any reason that breaks the by-laws, for a copy please request by email or look up online. Casual and Concession rates vary, depending on circumstances and types of concession cards that are held. Please check these with the Programs Officer.PrivacyAll information is strictly confidential and will not be passed onto third parties. As such, the information contained will only be used or referred to when there is a need to inform you about Toddler Time or other WCFC user group info.SignatureDateOFFICE USE ONLY - Term 1Payment DetailsPayment Type ___________ | Processed by _______ Membership Type ________ Recurring Payment Y/N Amount Paid $_____ | Date Paid ___/___/___ Other Details ______________________________Office Check ListReceiptSubscribedSquare / StripeCustomer Check ListAttendance SheetDatabaseBooking LinkMembership CreatedOFFICE USE ONLY - Term 2Payment DetailsPayment Type ___________ | Processed by _______ Membership Type ________ Recurring Payment Y/N Amount Paid $_____ | Date Paid ___/___/___ Other Details ______________________________Office Check ListReceiptSubscribedSquare / StripeCustomer Check ListAttendance SheetDatabaseBooking LinkMembership CreatedOFFICE USE ONLY - Term 3Payment DetailsPayment Type ___________ | Processed by _______ Membership Type ________ Recurring Payment Y/N Amount Paid $_____ | Date Paid ___/___/___ Other Details ______________________________Office Check ListReceiptSubscribedSquare / StripeCustomer Check ListAttendance SheetDatabaseBooking LinkMembership CreatedOFFICE USE ONLY - Term 4Payment DetailsPayment Type ___________ | Processed by _______ Membership Type ________ Recurring Payment Y/N Amount Paid $_____ | Date Paid ___/___/___ Other Details ______________________________Office Check ListReceiptSubscribedSquare / StripeCustomer Check ListAttendance SheetDatabaseBooking LinkMembership Created SubmitToddler Time 2021Confirm
