Signup Form Home / Join Playgroup Queensland / Signup Form Membership is FREE if you have a child under one! Become a member today and join the 10,000 families that use Playgroups as an exciting starting point for their children’s development. WE’D LIKE TO LEARN A LITTLE BIT MORE ABOUT YOU. By completing this Membership Form, you are agreeing to Playgroup Queensland Member Terms and Conditions. Do you have a child under one?*NoYesEmail* Your Name* First Last TelephoneMobile*Address* Street Address Address Line 2 Suburb State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Date of Birth* Date Format: DD slash MM slash YYYY Gender*Not StatedFemaleMaleIntersex or IndeterminatePrefer not to sayCountry of Origin*Prefer not to sayAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweLanguage spoken at Home*AfarAbkhazAvestanAfrikaansAkanAmharicAragoneseArabicAssameseAvaricAymaraAzerbaijaniSouth AzerbaijaniBashkirBelarusianBulgarianBihariBislamaBambaraBengali; BanglaTibetan Standard, Tibetan, CentralBretonBosnianCatalan; ValencianChechenChamorroCorsicanCreeCzechOld Church Slavonic, Church Slavonic, Old BulgarianChuvashWelshDanishGermanDivehi; Dhivehi; Maldivian;DzongkhaEweGreek, ModernEnglishEsperantoSpanish; CastilianEstonianBasquePersian (Farsi)Fula; Fulah; Pulaar; PularFinnishFijianFaroeseFrenchWestern FrisianIrishScottish Gaelic; GaelicGalicianGuaraníGujaratiManxHausaHebrew (modern)HindiHiri MotuCroatianHaitian; Haitian CreoleHungarianArmenianHereroInterlinguaIndonesianInterlingueIgboNuosuInupiaqIdoIcelandicItalianInuktitutJapaneseJavaneseGeorgianKongoKikuyu, GikuyuKwanyama, KuanyamaKazakhKalaallisut, GreenlandicKhmerKannadaKoreanKanuriKashmiriKurdishKomiCornishKyrgyzLatinLuxembourgish, LetzeburgeschGandaLimburgish, Limburgan, LimburgerLingalaLaoLithuanianLuba-KatangaLatvianMalagasyMarshalleseMāoriMacedonianMalayalamMongolianMarathi (Marāṭhī)MalayMalteseBurmeseNauruNorwegian BokmålNorth NdebeleNepaliNdongaDutchNorwegian NynorskNorwegianSouth NdebeleNavajo, NavahoChichewa; Chewa; NyanjaOccitanOjibwe, OjibwaOromoOriyaOssetian, OsseticPanjabi, PunjabiPāliPolishPashto, PushtoPortugueseQuechuaRomanshKirundiRomanianRussianKinyarwandaSanskrit (Saṁskṛta)SardinianSindhiNorthern SamiSangoSinhala, SinhaleseSlovakSloveneSamoanShonaSomaliAlbanianSerbianSwatiSouthern SothoSundaneseSwedishSwahiliTamilTeluguTajikThaiTigrinyaTurkmenTagalogTswanaTonga (Tonga Islands)TurkishTsongaTatarTwiTahitianUyghur, UighurUkrainianUrduUzbekVendaVietnameseVolapükWalloonWolofXhosaYiddishYorubaZhuang, ChuangChineseZuluIdentify as*AboriginalTorres Strait IslanderBoth Aboriginal and Torres StraitPacific IslanderNone of the abovePrefer not to sayDo you want to add an additional parent/carer to this membership?* No Yes Name of additional parent/carer* First Last Do you already attend a playgroup?YesNoPlaygroup NameMembership*How long would you like to sign up for?3 Months Membership6 Months Membership1 Year Membership2 Years MembershipPromo Code Total Membership Cost $ 0.00 Children Name Date of Birth Gender Identify as Disability Relationship to child Actions Edit Delete There are no Children. Add Child Maximum number of children reached. Preferred Method of ContactEmailPhoneCommentsHow did you hear about us?*Playgroup memberGoogle searchWebsiteWord of mouthSocial mediaBaby ExpoEventMessy Play MayChild Health NurseI agree that I:* Consent for future contact and to participate in research and evaluation. Consent to provide details to government departments. Have been provided with sufficient information to understand how my information may be used. Personal information collected on this form will be used by Playgroup Qld as it relates directly to the programs and services we provide to you and it is required by law. Your personal information will be handled in accordance with The Privacy Act 1988 (Cth), Australian Privacy Principles. Our Privacy Policy is available at playgroupqld.com.au. For information about our Privacy Policy please contact us by email info@playgroupqld.com.au or telephone 1800 171 882.CAPTCHAPlease note, on submission of your this form, you will be redirected to Paypal to complete your payment.
