Waiting List Application

Home/Waiting List Application

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Waiting List Application
Child Information
Surname
Given Name/strue
Date Of Birth
E.D.D
CRN (if known)
Ethnicity/ Culturetrue
Languages spoken at hometrue
Known disabilities
Known Allergies/ Intolerances
Child Care Requirements
Month Required
Year Required
No. Of Days Requiredtrue
What are your preferred day/strue
Are you flexible with your days?true
Are you flexible with your start date?you like
Priority Access
Please tick the applicable priority of accesstrue
Parent/Guardian Information
Parent/Guardian #1
First Nametrue
Family Nametrue
Date Of Birthtrue
Home Addresstrue
Postal Address (If different to home address)
Home Phonetrue
Work Phonetrue
Mobiletrue
Are you Aboriginal or Torres Strait Islander?
Your Ethnicity/Culture
Your Religion
Languages Spoken
CRN

Parent/Guardian #2

First Nametrue
Family Nametrue
Date Of Birthtrue
Home Addresstrue
Postal Address (If different to home address)
Home Phonetrue
Work Phonetrue
Mobiletrue
Are you Aboriginal or Torres Strait Islander?
Your Ethnicity/Culture
Your Religion
Languages Spoken
CRN
Additional Information
It is your responsibility to notify us of any changes to the information supplied. Some changes to circumstances may affect your chances of being offered a placement within our service. By filling out this form, your child’s name will go on the Waiting List. You will be contacted when a suitable position becomes available. This form does not guarantee that you will be offered a position.
Declaration
The information I have supplied within this form is to the best of my knowledge, true and correct and I will inform the service if any changes occur.
Declaration Acceptanceyou like
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