St Luke’s Mini Climbers

Family Enrolment Form

Mother’s Name

Father’s Name

Carer’s Name (If Child does not attend with Parent)

Children’s Name

Date of Birth

Date of Birth

Date of Birth


Post Code:

Email Address

Home Phone no.

Mobile Phone no.

Language spoken at home:

Allergies/ Food Intolerances

Do you or your children have any allergies or food intolerances we need to be mindful of when planning activities and morning tea?


I am happy for my child/children to be photographed and for their photo to be displayed in the playtime advertising                YES                NO

Play Group Contact List

Are you happy for your contact details to be on a contact list, distributed amongst our St Luke’s Mini Climbers families only?

                       YES                               NO

Parents/Carers signature