Guyahyn Playgroup Enrolment Form

Responsibility for children attending Guyahyn Playgroup:

I understand that I am responsible for my child at all times while at Guyahyn Playgroup. If I am sending my child to the group with another adult, I understand that they will be responsible for my children while at the group. Guyahyn Playgroup is a family-based activity involving parent participation. I understand that it is not a childcare program, and children are not to attend without a parent or assigned guardian.

DD slash MM slash YYYY

Or estimated age if date unknown
Do you identify as Aboriginal or Torres Strait Islander?
English or Other
Gender
Or estimated age if date unknown
Or estimated age if date unknown
Or estimated age if date unknown
Or estimated age if date unknown
Or estimated age if date unknown
Are your children Aboriginal or Torres Strait Islander

If you require transport assistance to attend Group, please provide your address and contact details below:

Do you identify as having one or more of the following impairments, conditions or disabilities?
We often take photos to record our program and the learning experiences – do you give permission for Guyahyn Educators to take photos of your self/your children for our daily reflection journal?
WE also share photos of the activities our families enjoyed on the Guyahyn Facebook page. The page is a closed group and used to share information with the group participants. Do you give permission for Guyhayn to share photos of yourself/your children on the Guyahyn Facebook page?

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I understand how the information I have provided on this form will be used: I have read and agree to the code of conduct:

">Use of client information:

The information that you provide on this form includes your personal information. Your personal information is protected by law, including the Privacy Act 1988. Your personal information collected on this form is used primarily for the Guyahyn project to evaluate outcomes and participation in the program. As part of the services provided to you by the Guyahyn Project – Murwillumbah Communities for Children, we need to collect some information about you to assist the Australian Government Department of Social Services to conduct performance reporting and research relating to the services that you receive from this organisation. To assist this process, Murwillumbah Communities for Children, will enter your personal information onto the DSS Data Exchange web-based portal which is administered by the Department of Social Services. The Department of Social Services will not use your personal information in an identifiable form when conducting its research and evaluation, except where you have agreed or it is required by law. You can find more information about the way the Department of Social Services will manage your personal information, including information about accessing and correcting personal information held on the DSS Data Exchange and making privacy complaints at the DSS website. For information about how Murwillumbah Communities for Children, manages your personal information, please contact Lara Bennett on 0431951162

Do you consent to be contacted by the Project Coordinator in the future for surveys, research or evaluation exercises?

I understand how the information I have provided on this form will be used: I have read and agree to the code of conduct:

DD slash MM slash YYYY

The PDF version is available for download from the button below

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