Creche Enrolment Form » Eaton Recreation Centre

Main Opening Hours Table
Monday	5:30am-8:00pm
Tuesday	5:30am-8:00pm
Wednesday	5:30am-8:00pm
Thursday	5:30am-8:00pm
Friday	5:30am-8:00pm
Saturday	7.45am – 11.00am
Sunday	Closed

Child's First Name*

Child's Last Name*

Child's Date of Birth*

Gender*

FemaleMalePrefer not to say

Does your child have a diagnosed disability or special needs?*

YesNo

Does your child have any Allergies / Anaphylaxis / Epi Pen*

YesNo

Please tell us a little more about your child and their needs*

Parent / Guardian First Name*

Home Address

Parent / Guardian Last Name*

Relationship to child*

Contact Number*

Email Address*

Parent 2 / Guardian 2 First Name*

Parent 2 / Guardian 2 Last Name*

Home Address

Relationship to child*

Contact Number*

Email Address

Emergency Contact Name*

Emergency Contact Number*

As the responsible adult, I hereby give the Shire of Dardanup and Eaton Recreation Centre permission to use photographs/videos of my child. I accept that these photographs/videos may be used for promotional purposes on social media, website and print formats.*

YesNo

I acknowledge that a Parent/Guardian must remain on the premises while their child is attending Creche.*

YesNo

I/we have read, understood and accept the terms, conditions and information surrounding creche use and the creche handbook.*