Child care waiting list application

Child's family name

Child's first name

Child's date of birth or expected date of birth 

Gender GenderFemaleMale

Proposed Booking Details

Monday - Arrive time

Monday - Depart time

Tuesday - Arrive time

Tuesday - Depart time

Wednesday - Arrive time

Wednesday - Depart time

Thursday - Arrive time

Thursday - Depart time

Friday - Arrive time

Friday - Depart time

From what date: 

For weeks

Or until a date: 

Ongoing Ongoing For ongoing tick this box

Access Guidelines

To help us equitably fill vacant places, please tick the appropriate priority boxes below: To help us equitably fill vacant places, please tick the appropriate priority boxes below: Child at risk of abuse or neglect OR family in crisis. Child of a single parent who satisfies, or of parents who both satisfy, the work/training/ study test. Any other child

Within the main categories above, priority should also be given to the following: Within the main categories above, priority should also be given to the following: Children in an Aboriginal or Torres Strait Islander family. Children in a family which includes a disabled person. Children in a family which includes an individual whose adjusted taxable income does not exceed the lower income threshold, or who or whose partner is on income support. Children in a family from a non-English speaking background. Children in a socially isolated family. Children of a single parent family. None of the above

Parent / Guardian applying

Name

Relationship to child

Contact priority

Primary language

Address

Phone (home)

Phone (work)

Phone (mobile)

Email

Application

I wish to apply for child care placement as detailed at this service. I understand that I must apply to FAO/Centrelink for Child Care Subsidy if I intend to claim such benefit. I understand that to maintain this place on the waiting list, I / We need to contact the Director of the service at least every three months to confirm our continuing interest. Not doing so will mean the deletion of this application from the waiting list. Spots not taken upon being offered are put to the back of the waiting list. I wish to apply for child care placement as detailed at this service. I understand that I must apply to FAO/Centrelink for Child Care Subsidy if I intend to claim such benefit. I understand that to maintain this place on the waiting list, I / We need to contact the Director of the service at least every three months to confirm our continuing interest. Not doing so will mean the deletion of this application from the waiting list. Spots not taken upon being offered are put to the back of the waiting list. By ticking this box I approve the application process

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