Bank Details Enrolment Form

A form for parents or guardians to record the bank details needed to set up direct debit payments for the childcare center.

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Center Name

Child's Name (1)

First Name

Last Name

Child's Date of Birth (1)

Number of Children attending GCP

1 Child 2 Children 3 Children

Child's Name (2)

First Name

Last Name

Child's Date of Birth (2)

Child's Name (3)

First Name

Last Name

Child's Date of Birth (3)

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Phone Contact

Parent/Guardian Email

Bank

Bank (Other)

BSB Number

Account Number

Bank Account Name

Declaration of Authority

I declare that I have the authority to authorize this bank debit

Declaration of Information

I declare that the information provided is true and correct

Parent/Guardian Signature

Sign here

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