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Application for Enrolment Form
aitwpadmin
2023-10-25T16:30:33+11:00
Application for Enrolment Form
Child's Surname
(Required)
Child's First Name
(Required)
Child's Date of Birth
(Required)
Month
Day
Year
Parent 1 Name
(Required)
Parent 2 Name
Parent 1 Phone
(Required)
Parent 2 Phone
Parent 1 Email
(Required)
Parent 2 Email
Parent 1 Place Of Employment/Education Institute
(Required)
Parent 2 Place Of Employment/Education Institute
Parent 1 Work Phone
Parent 2 Work Phone
Priority of placement is a Commonwealth Government Directive. DEEWR state the Priority of Access must be given to the following categories, please tick which applies to you:
(Required)
First Priority: a child at risk of serious abuse or neglect
Second Priority: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test under Section 14 of the 'A New Tax System (Family Assistance) Act 1999'
Third Priority: any other child.
Do you or your child have any health problems or disability?
Any special family circumstances?
Has your child attended Long Day Care before?
(Required)
Yes
No
If Yes, which centre did they attend?
Does your child currently attend another centre?
(Required)
Yes
No
If yes, which days?
Monday
Tuesday
Wednesday
Thursday
Friday
Do you have a case worker with Communty Services?
(Required)
Yes
No
If Yes, what is the name of the worker?
What times do you require?
Please indicate when you would like attendance from (date)
Month
Day
Year
Thank you for your application, we will contact you for an interview when a suitable position becomes available.
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