Program Registration Form - Mobile

The personal information requested is being collected and will only be used to ensure that Banksia Gardens procedures are effective, in accordance with the Information Privacy Act 2014. This information will only be used for its intended purpose by Banksia Gardens Community Services and will not be disclosed to any other party except as required by law. If you fail to provide this information, the registration may not be processed. You may access the information by contacting Banksia Gardens Community Services on 9309 8531
Authorising BGCS to use images of your children for the organisation’s promotional purposes.

I Consent

Please indicate whether you give our team consent to speak to your child/children's school teacher(s) about their educational needs:

I Consent

Do you consent to Banksia Gardens to take photographs of your children for promotional purposes? (We will consult you before publishing any images of your children if you give consent)

I Consent

I understand that as part of the activities on offer in the Banksia Gardens Study Group Program, my children will take part in sports, art and healthy movement programs which have a moderate risk of personal injury. I have been informed about the processes BGCS uses to minimize these risks and I therefore authorise my children to be part of the Banksia Gardens Study Group.

I Consent


Carer First Name

Carer Last Name

Email Address

Contact Number

Relationship to Participants

Add New


Preferred Spoken Language


Would you like an interpreter?

Emergency Contact

Contact First Name

Contact Surname

Contact Number

Relationship to you

Participant Details and Attendance Record

First Name

Last Name

Date of Birth (dd/MM/yyyy)

Medical conditions, disabilities, allergies, or additional needs?


Grade Level


Program ID 2


Program Name

Attendance Tracking ID

Program ID

Registered 2022

Registered 2023

In Group?

Special needs?

Approved for Attendance

Sub Group