Primary Contact
First Name:	Surname:
Mobile:	Email:

Member Type: Family ( 1 Membership) $60 : $ 60.0 Family (2 Memberships) $70 : $ 70.0 Family Daycare/Playgroups/Church Groups (2 Memberships) $90 : $ 90.0 Playgroups /Church groups/Family Daycare (2 Memberships) $90 : $ 90.0 Grandparents (1 Membership) $45 : $ 45.0 Grandparents (2 Membership) $55 : $ 55.0 Health Care Card (1 Membership) $45 : $ 45.0 Health Care Card (2 Memberships) $55 : $ 55.0

Nationality: Other

Address:
Suburb Armstrong Creek Belmont Geelong Geelong West Grovedale Highton Moriac Newtown South Geelong Waralilly Waurn Ponds Other or not listed
Pcode	State:

ID Card and number: (Drivers Licence Number, medicare card):

How did you find us?: Friend Kids Voice Advert Member Neighbour Newspaper Other Playgroup Previous Member street sign visit to Grovedale Children's Hub website

How can you help? (select more than one) Toy Purchasing and Processing Fundraising and Events Marketing and Communications Distributing posters to community businesses Administration and Finance Website and IT Support I want to help but I`m not sure how! Please contact me Clear

Conditions of membership

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Code of Conduct and Child Safe Policy.

By clicking yes I agree to the child safe policy at all times:

WAIVER, RELEASE AND INDEMNITY FOR BICYCLES AND SCOOTERS

By clicking Yes I agree to the Helmet waiver, release and Indemnity for Bicycles and scooters.