PlayConnect+ Registrations

PlayConnect+ Registrations
PlayConnect+ Playgroups are funded by Autism Queensland and each family attending is required to register with the program by completing a registration form which is returned to Playgroup NSW. Please note that this information is recorded securely within the DEX portal with information kept private and confidential.

All registered members will receive free membership with Playgroup NSW.
Select registration type*
Select group*

Participating child with disability
Child's name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Gender*
What is the child's diagnosis?*
Other:*
Is the child eligible for NDIS?*
If eligable for NDIS, does the child have a NDIS plan?*
How did you hear about the PlayConnect+ Program?*
What country was the child born in?
Does the child identify as Aboriginal or Torres Strait Islander?*
Does the child identify as culturally or linguistically diverse?*

Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Gender*
What country was the child born in?
Does the child identify as Aboriginal or Torres Strait Islander?*
Does the child identify as culturally or linguistically diverse?*

Child without disability
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Gender*
What country was the child born in?
Does the child identify as Aboriginal or Torres Strait Islander?*
Does the child identify as culturally or linguistically diverse?*

Primary carer
Name*

First NameLast Name
Carer type*
Date of birth*

DayMonthYear
Date
Gender*
Mobile number*
Please enter a valid phone number.
Postcode*
Email*
example@example.com
Do you identify as Aboriginal or Torres Strait Islander?*
Do you identify as culturally or linguistically diverse?*
Do you have a disability?*
Are you eligible for NDIS?*
If eligible for NDIS, do you have a NDIS plan?*
What country were you born in?*
What language do you usually speak at home?*
What is your highest level of education/qualification?
What is your household composition?
Are you a carer?
What is your employment status?
Are you currently experiencing homelessness?
Where did you hear about this playgroup?
Consent Policy

All families participating in the PlayConnect + Program run through Playgroup NSW are required to complete a Registration Form with personal information about themselves and their children. Your personal information is protected by law, including the Commonwealth Privacy Act.

As part of the funding contract the personal information that is collected from you is required to be entered into an IT system called the ‘DATA EXCHANGE’ which is hosted by the Australian Government Department of Social Services (DSS). The personal information that is stored on the Data Exchange is only disclosed to us for the purposes of providing a service to your family.

DSS de-identifies your data, which means they remove information that identifies you and/or your child. DSS combines your data with other clients data to identify trends at the program level and use the information to develop policy, conduct research and evaluations.

DSS may use this data to produce reports and these reports maybe shared with other organisations. You can find more information about how DSS will manage your personal information in the DSS Privacy Policy on their website: http://www.dss.gov.au/privacy-policy

PlayConnect+ staff will be requesting that you sign consent at the first Playgroup you attend.

You do not have to consent to sharing your personal information with DSS and this will not affect the service you receive. If you do not consent you can ask for your information to be removed at anytime.

Questions and Further Enquiries

For more information please email Playgroup NSW at admin@playgroupnsw.org.au
I acknowledge that I have read (or have had explained) and understand the information outlined above*

YesNo
I consent to the information being entered onto the databases explained in this form.*

YesNo
Would you like to receive our eNewsletter?*

YesNo
Should be Empty:

PlayConnect+ Registrations

Participating child with disability

Child without disability

Primary carer

Consent Policy