EP Registration – Eastern Districts Alliance Church

zEDAC Play Registration

Complete this form to secure your spot at EDAC Play Mondays or Wednesdays for 2020. Fees are $5/session or $40/term with EFTPOS available at the welcome desk before the session starts. Please note, priority will be given to those who live in the immediate local area (eg. Dayton, Brabham, Caversham & West Swan) and EDAC members.

I wish to register for *

Please register your family for ONLY ONE of these two options to allow us to invite more families into our community.

How did you find out about EDAC Play? *

Friend/relative
EDAC Website/Social Media
Advertisement

Other (please specify):

Church (if you attend one)

If you're involved with a church (EDAC or other) please list it here.

Parent/Guardian Details

Parent/Guardian 1 Name *

First

Last

E-mail *

Phone *

Date of Birth *

Relationship to Child/ren *

Emergency Contact *

First

Last

Phone *

Family Details

Family Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Private Health Provider (if held)

Private Health Insurance No.

Participant Details

Please complete details for children who attend MM or EP. Please note that parents are responsible for their child/ren at all times.

Child 1 Name *

First

Last

Date of Birth *

Gender *

Medicare No.

Allergies, Impairments or Medications

Please include any info that may better enable us to care for your child, including severity of any allergies and treatment.

Child 2 Name

First

Last

Date of Birth

Gender

Medicare No.

Allergies, Impairments or Medications

Please include any info that may better enable us to care for your child, including severity of any allergies and treatment.

Child 3 Name

First

Last

Date of Birth

Gender

Medicare No.

Allergies, Impairments or Medications

Please include any info that may better enable us to care for your child, including severity of any allergies and treatment.

Child 4 Name

First

Last

Date of Birth

Gender

Medicare No.

Allergies, Impairments or Medications

Please include any info that may better enable us to care for your child, including severity of any allergies and treatment.

Parent/Guardian Agreement

I consent to appropriate use by EDAC of photographs or videos taken that include me and/or my child/ren. Eg. inclusion on our Facebook page, website or a flyer. *

A note on Social Media: photos of families from this program cannot be used on any social media platform unless they contain only your child/ren or children where you have permission from parents. Please ensure you do not load photos with groups of children or adults where no permission has been granted. Filming or loading entire songs is prohibited. Please limit film footage to your child/ren only and to a short portion of the song.

I accept EDAC's Privacy Policy *

To view our Privacy Policy, please visit the 'About Us' section of our website.

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