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*This field is required.

* Required Field.

Child's Last Name*This field is required.

* Required Field.

Child's Date of Birth*This field is required.

* Required Field.

Gender*This field is required.

FemaleMalePrefer not to say

Does your child have a diagnosed disability or special needs?*This field is required.

YesNo

If yes please provide additional information:

* Required Field.

Does your child have any Allergies / Anaphylaxis / Epi Pen*This field is required.

YesNo

If yes please provide additional information and action plan:

* Required Field.

Please tell us a little more about your child and their needs*This field is required.

* Required Field.

Parent / Guardian First Name*This field is required.

* Required Field.

Home Address

Parent / Guardian Last Name*This field is required.

* Required Field.

Relationship to child*This field is required.

* Required Field.

Contact Number*This field is required.

* Required Field.* Please enter a valid phone number

Email Address*This field is required.

* Required Field.* Please enter a valid email address

Parent 2 / Guardian 2 First Name*This field is required.

* Required Field.

Parent 2 / Guardian 2 Last Name*This field is required.

* Required Field.

Home Address

Relationship to child*This field is required.

* Required Field.

Contact Number*This field is required.

* Required Field.* Please enter a valid phone number

Email Address

* Please enter a valid email address

Emergency Contact Name*This field is required.

* Required Field.

Emergency Contact Number*This field is required.

* Required Field.

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.*This field is required.

YesNo

* Required Field.

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

YesNo

* Required Field.

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

* Required Field.

Type the code from the image:

Do not fill this textbox.