Child Details Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Primary Language Date of Birth or Expected Date of Birth MM DD YYYY Gender Male Female Prefer not to say Enrolling Parent/Guardian Details Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email Relationship to Child Primary Language Contact Method Email Home Phone Work Phone Mobile Home Phone (###) ### #### Work Phone (###) ### #### Mobile (###) ### #### How did you hear about us? Option 1 Option 2 Booking Request Arrival & Departure Times Please fill in the days and times you wish to drop off and pick up your child. Access Guidelines As a child care service which receives Child Care benefit from the Commonwealth Government, we abide by the Priority of Access Guidelines as set out in Child Care Benefit (Eligibility of Child Care Services for Approval and Continued Approval) Determination 2000. To enable us to apply these guidelines correctly please select one of the options below: Child at risk of serious abuse or neglect or Family in Crisis Family who satisfies the recognised work, training, study tests All other families Agreement I wish to apply for placement as detailed at the St Peters Child Care Centre and Preschool. I understand that I must apply to FAO/Centerlink for Child Care benefit if I intend to claim such benefits. I understand that to maintain this place on the waiting list I must contact the Director at least every three (3) months to confirm our continuing interest. Not doing so will mean the deletion of this application from the waiting list. I certify that the information entered upon this form is true to the best of my knowledge and I undertake to inform the Service if any of these details change. Thank you! Waiting List Application FormFill in the form below to become a part of our waitlist. When a spot becomes available, we will contact you
