Waiting List Form

Expand your Child’s Horizon

Complete our waiting list form

Registering your child on the waiting list does not necessarily mean you have secured a spot. It simply means you have registered and, should a place become available which suits your particular needs, you will be contacted.

Child's Details

First Name: *

Last Name: *

Child's Date of Birth: *

Child's Gender: *

Person making this application

First Name: *

Last Name: *

Your Email: *

Address: *

Phone/Mobile: *

Best contact option: *

Other Parent or Guardian

First Name: *

Last Name: *

Your Email: *

Address: *

Phone/Mobile: *

Best contact option: *

Description of Child Care Needed

Commencement Date: *

Child's Age: *

Days Needed*

MondayTuesdayWednesdayThursdayFriday

Assessment of Priority as per FACSIA Guidelines

Reason for needing care. Please select an option (required)

Child at risk of abuse or neglectChild of a single parent who satisfies, or of parents who satisfy, the work/training/study test under Section 14 of A New Tax System-Family Assistance-Act 1999Any other child

Please enter an answer in digits:

seventeen + six =

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