Waitlist Application Step 1 of 3 33% Child's Name* First Last Date of Birth* Parent OneName* First Last Date of Birth* Address* Street Address City State / Province / Region ZIP / Postal Code Home PhoneWork PhoneMobile*Email* Occupation*Languages Spoken*Parent TwoName First Last Date of Birth Address Street Address City State / Province / Region ZIP / Postal Code Home PhoneWork PhoneMobileEmail OccupationLanguages SpokenWhich Parent will be registering for Child Care Benefit/Rebate?*Parent OneParent Two Tick your preferred days* Monday Tuesday Wednesday Thursday Friday When would you like attendance to commence?* In order to comply with the Australian Government’s Priority of Access Guidelines (see below) and to ensure priority of enrolment on a needs basis, you are requested to supply the following information.Please Specify Two parent family Single parent family Working full-time Working part-time Seeking employment Home duties Studying Do you or your child(ren) have any health problems or disabilities?YesNoDetails Do you have other children?YesNoDetails Are there are other special circumstances?YesNoDetails If you would like to view the Centre, please select one of the following dates. All visits commence at 10am for approximately 30 minutes. Please feel free to bring your child.Preferred Viewing Thurs 7th march Tues 9th April Fri 17th May Thurs 13th June Tues 16th July Fri 16th August Thursday 19th September Tuesday 15th October Friday 15th November By filling out this form your child’s name goes onto a waiting list. There is no guarantee of placement in the Centre. Please inform the Centre of any changes in your circumstances as this could save any future inconvenience or misunderstanding.Signature* NOTE Priority is given to siblings When offering places to new families we follow Priority of Access Guidelines There are three levels of priority that the Centre must follow when filling vacant places: Priority 1 - a child at risk of serious abuse or neglect Priority 2 - 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 Priority 3 - any other child Within these main categories priority also has to be given in a certain manner, more details of which can be found in our Priority of Access Policy.Application Fee Price: $ 20.00 NameThis field is for validation purposes and should be left unchanged.