Enrolment Step 1 - Coastwide Child and Family Services

Date of Enrolment Enquiry

Parent/Guardian Personal Details :

Parent/Guardian 1 Full Name *

Phone Contact:

Mobile Phone Number *

Don't have a mobile phone?

Please tick here and add your preferred contact phone number in the field above, including the area code. Thank you.

Preferred Contact Number *

Address *

Suburb *

Email *

Will you be claiming child care fee assistance? We recommend that you visit www.humanservices.gov.au as soon as possible to make a claim for Child Care Subsidy.

Care Requirements:

Preferred Start Date *

Please click on field and use calendar to select date

Have you used Family Day Care before? *

Yes

No

Please specify the name of the Provider, or if uncertain, the name of the Educator? *

Are you enrolling a sibling? *

Yes

No

Name of Educator *

I am seeking care for child/children *

Child 1 Personal Details:

Child 1 Full Name *

Date of Birth

Day *

Month *

Year *

Gender *

Is your child of Aboriginal or Torres Strait Islander descent? *

Is your child: *

Does your child have any of the following medical conditions, additional needs, allergies or intolerances, including any disabilities? *

None

Asthma

Diabetes

Allergies

Diagnosed at risk of anaphylaxis

Epilepsy

Anxiety

Autism

ADHD

Processing Disorder

Speech or Language Delay

Disability

Dietary Intolerances or Sensitivities

Other

Please provide more information *

Is your child fully immunised? *

Does your child have any parenting orders?

If yes, please provide any relevant information which impacts on your vacancy enquiry?

Please list the days and hours you are looking for below so that we can match up with the right educator:

To add more days click the 'Add day' button

Day *

Drop Off *

:

Collection time *

:

Add day Clear

What type of child care are you looking for? *

Please indicate if this care will be: *

What school do they attend *

Are these days flexible? *

Child 2 Personal Details:

Child 2 Full Name *

Date of Birth

Day *

Month *

Year *

Gender *

Is your child of Aboriginal or Torres Strait Islander descent? *

Is your child *

Does your child have any of the following medical conditions, additional needs, allergies or intolerances, including any disabilities? *

None

Asthma

Diabetes

Allergies

Diagnosed at risk of anaphylaxis

Epilepsy

Anxiety

Autism

ADHD

Processing Disorder

Speech or Language Delay

Disability

Dietary Intolerances or Sensitivities

Other

Please provide more information *

Is your child fully immunised? *

Does your child have any parenting orders?

If yes, please provide any relevant information which impacts on your vacancy enquiry?

Please list the days and hours you are looking for below so that we can match up with the right educator:

To add more days click the 'Add day' button

Day *

Drop Off *

:

Collection time *

:

Add day Clear

What type of child care are you looking for? *

Please indicate if this care will be: *

What school do they attend *

Are these days flexible? *

Child 3 Personal Details:

Child 3 Full Name *

Date of Birth

Day *

Month *

Year *

Gender *

Is your child of Aboriginal or Torres Strait Islander descent? *

Is your child: *

Does your child have any of the following medical conditions, additional needs, allergies or intolerances, including any disabilities? *

None

Asthma

Diabetes

Allergies

Diagnosed at risk of anaphylaxis

Epilepsy

Anxiety

Autism

ADHD

Processing Disorder

Speech or Language Delay

Disability

Dietary Intolerances or Sensitivities

Other

Please provide more information *

Is your child fully immunised? *

Does your child have any parenting orders?

If yes, please provide any relevant information which impacts on your vacancy enquiry?

Please list the days and hours you are looking for below so that we can match up with the right educator:

To add more days click the 'Add day' button

Day *

Drop Off *

:

Collection time *

:

Add day Clear

What type of child care are you looking for? *

Please indicate if this care will be: *

What school do they attend *

Are these days flexible? *

Child 4 Personal Details:

Child 4 Full Name *

Date of Birth

Day *

Month *

Year *

Gender *

Is your child of Aboriginal or Torres Strait Islander descent? *

Is your child *

Does your child have any of the following medical conditions, additional needs, allergies or intolerances, including any disabilities? *

None

Asthma

Diabetes

Allergies

Diagnosed at risk of anaphylaxis

Epilepsy

Anxiety

Autism

ADHD

Processing Disorder

Speech or Language Delay

Disability

Dietary Intolerances or Sensitivities

Other

Please provide more information *

Is your child fully immunised? *

Does your child have any parenting orders?

If yes, please provide any relevant information which impacts on your vacancy enquiry?

Please list the days and hours you are looking for below so that we can match up with the right educator:

To add more days click the 'Add day' button

Day *

Drop Off *

:

Collection time *

:

Add day Clear

What type of child care are you looking for? *

Please indicate if this care will be: *

What school do they attend? *

Are these days flexible? *

Do you have a Preferred Educator *

Yes

No

Preferred Educator or Service: *

Location of Family Day Care service:

Please ranking in order of preference, ranking your first preference 1.

Preference 1

Preference 2

Preference 3

Ready to Enrol

Parent/Guardian Personal Details :

Phone Contact:

Care Requirements:

Child 1 Personal Details:

Please list the days and hours you are looking for below so that we can match up with the right educator:

Child 2 Personal Details:

Please list the days and hours you are looking for below so that we can match up with the right educator:

Child 3 Personal Details:

Please list the days and hours you are looking for below so that we can match up with the right educator:

Child 4 Personal Details:

Please list the days and hours you are looking for below so that we can match up with the right educator:

Location of Family Day Care service: