Primary Contact
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Second Borrower:
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Member Type: Family with 1 Child : $ 35.0 Family with 2 Children : $ 35.0 Family with 3 Children : $ 35.0 Family with 4 Children : $ 35.0 Family Day Care : $ 50.0

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Child Name:	Gender MF	Date of Birth:
Child Name:	Gender MF	Date of Birth:
Child Name:	Gender MF	Date of Birth:

Address:
Suburb: Adelaide Allenby Gardens Andrews Farm Angle Vale Athelstone Banksia Park Beaumont Beulah Park Birdwood Birkenhead Blair Athol Blakeview Bowden Brahma Lodge Broadview Brompton Burnside Burton Campbelltown Cheltenham Clearview Cockatoo Valley Craigmore Cromer Cudlee Creek Cumberland Park Davoren Park Dernancourt Direk Dry Creek Elizabeth Elizabeth Downs Elizabeth East Elizabeth North Elizabeth Park Elizabeth South Elizabeth Vale Enfield Ethelton Evanston Gardens Evanston Park Evanston South Fairview Park Felixstow Firle Flinders Park Fulham Fulham Gardens Fullarton Gawler East Gawler South Gilberton Gilles Plains Golden Grove Golden Grove Village Gould Creek Greenacres Greenwith Gulfview Heights Gumeracha Hackney Hampstead Gardens Hazelwood Park Hectorville Hewett Highbury Hillbank Hillcrest Holden Hill Hope Valley Houghton Humbug Scrub Ingle Farm Inglewood Kensington Gardens Kensington Park Kersbrook Kilburn Kilkenny Klemzig Largs Bay Largs North Lewiston Lightsview Lobethal Lower Hermitage Lyndoch Magill Manningham Marden Mawson Lakes Maylands Middleton Millbank Modbury Modbury Heights Modbury North Mount Pleasant Munno Para Munno Para West Nailsworth Newton North Adelaide North Haven North Upper Hermitage Northfield Northgate Northgate Nuriootpa Oakden One Tree Hill Osborne Ottoway Para Hills Para Hills West Para Vista Para Vista Paracombe Paradise Parafield Gardens Paralowie Payneham Payneham South Plympton Park Pooraka Prospect Queenstown Redwood Park Ridgehaven Ridleyton Rostrevor Royal Park Salisbury Salisbury Downs Salisbury East Salisbury Heights Salisbury North Salisbury Park Salisbury Plain Seaton Secombe Gardens Sefton Park Semaphore Smithfield Springton St Agnes St Clair Stepney Surrey Downs Taperoo Tea Tree Gully Tranmere Trinity Gardens Tununda Uleybury Underdale Upper Hermitage Valley View Virginia Vista Walkley Heights West Croydon West Lakes Shore Willaston Williamstown Windsor Gardens Woodside Woodville Woodville Gardens Woodville West Wynn Vale Yatala Vale Yattalunga Other or not listed
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How did you find us?: Brochure Council Facebook Family Friend Library Local Paper Member Newspaper Other Playgroup Previous Member 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 Management Committee Graphic Design Professional skills - e.g., OT or Speech Pathologist Clear

Conditions of membership

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WAIVER, RELEASE AND INDEMNITY FOR BICYCLES AND SCOOTERS

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