Online Form - Day Care Swipe Card Application Form

To obtain a swipe card for One Tree Day Care please fill out the form below.

Terms and Conditions

Please click here for the full terms and conditions.

First Name*

Surname:*

DOB:

Address

Email Address

Emergency contact

First Name:

Surname:*

DOB:*

Address:

Replacement cards: $30 ( Non-Refundable)

Declaration

I understand that this card only entitles me to access the Kambalda Community Recreation Facility through the Child Care Centre.

Access during day-care operational hours Monday to Friday 7.30am -4.30pm.

If this card is misplaced I understand I will incur a fee of $30 for another replacement card.

I acknowledge that the service access card to enter the building is a may not be transferred to any other person without he consent of the Shire of Coolgardie.

I acknowledge that during such times I am on the premises (or its surrounds) both my property and my person shall be at my own risk and I will not hold the Shire of Coolgardie (or its employees) liable for any personal injury or loss of property however caused.

I have received the Terms and Conditions of which I agree to observe and be bound.

Do you agree to adhere to the terms and conditions (please see link above to download full terms and conditions.) By ticking yes, you confirm agreement with conditions.

Yes

Members Signature: ___________________________________

Date: _____________________