Waiting List Application

Child Details

First Name*

Last Name*

Address*

Date of Birth or Expected Date of Birth*

Gender*
MaleFemale

Languages Spoken at Home

Known disabilities, allergies or illness

PREFERRED ATTENDANCE

Date care is required from*

Tick Preferred Days*
MonTuesWedThursFri

Are you flexible with your days?*
YesNo

Are you flexible with your start date?*
YesNo

PARENT ONE DETAILS

Title*

First Name*

Last Name*

Address*

Home Phone

Work Phone

Mobile

Email

Nationality

Languages Spoken

Are you any of the following:
WorkingHave a disabilityMaternity/Paternity LeaveSeeking workStudyingSingle ParentNot WorkingOf Aboriginal/Torres Island descent

PARENT TWO DETAILS

Title*

First Name*

Last Name*

Address*

Home Phone

Work Phone

Mobile

Email

Nationality

Languages Spoken

Are you any of the following:
WorkingHave a disabilityMaternity/Paternity LeaveSeeking workStudyingSingle ParentNot WorkingOf Aboriginal/Torres Island descent

Please indicate the applicable priority of access:
Both parents or single parent working or studyingChildren of parents with a disability/disadvantageChildren at risk of abuse or neglectOne or both parents at home

Please understand that submitting the waitlist form does not guarantee that your child will be offered a position on your requested start date. We will notify you once a position that suits your request becomes available.

You may contact the centre at any time for an update on your child's position on the waitlist.

Families are required to update the Centre with any changes to the waiting list application.