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GLC (08) 9754 3600 NCC (08) 9755 3966

Geographe Leisure Centre
Naturaliste Community Centre

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Creche Enrolment GLC

Please complete the form and acknowledge you have read the creche general information brochure.

Date of Enrolment*

* Required Field.

Name of Child:*

* Required Field.

Date of Birth:*

* Required Field.

Gender*

MaleFemale

* Required Field.

Address:

Street Address:*

* Required Field

City:*

* Required Field

State:*

* Required Field

Post Code:*

* Required Field

Country:*

* Required Field

Parent/Guardian's Name:

Mobile Contact #:

Phone Contact (W or H):

Email*

* Required Field.

Emergency Contact Name:

Mobile Contact #:

Is your child currently immunised?*

YesNo

* Required Field.

Immunisation current as of:*

* Required Field.

Does your child suffer with any medical conditions (allergies, asthma, epilepsy etc.)?*

YesNo

Please outline in more detail medical condition and medications taken:: *

* Required Field.

Action Plan.

YesNo

If you answered Yes to above medical issues a Action plan is required at time of enrolment.

Please email a copy to glc@busselton.wa.gov.au

General Health - please indicate if your child is experiencing any of the following issues:

Photography - do you give permission for your child to be photographed by centre staff whilst participating in creche activities for City of Busselton promotional purposes?*

YesNo

* Required Field.

Please acknowledge you have read and understood creche policy outlined.*

YesNo

* Required Field.

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Contact Us

Geographe Leisure Centre (GLC)

Queen Elizabeth Avenue and Recreation Lane, West Busselton WA 6280
(08) 9754 3600
(08) 9752 4958
glc@busselton.wa.gov.au

Naturaliste Community Centre (NCC)

21 Dunsborough Lakes Dr, Dunsborough WA 6281
(08) 9755 3966
ncc@busselton.wa.gov.au

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Naturaliste Community Centre