Enrolment Step 1 - Coastwide Child and Family Services

Enrolment Step 1

Date of Enrolment Step 1

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 *

Are you of Aboriginal or Torres Strait Islander descent? *

Will you be claiming Grandparents Child Care Benefit or Special Child Care Benefit? *

Care Requirements:

Preferred Start Date *

Please click on field and use calendar to select date

Have you used Family Day Care before? *

Yes

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

Are you enrolling a sibling? *

Yes

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? *

Does your child have any additional needs, allergies or intolerances, including any disabilities? *

If Yes please specify *

Is your child fully immunised? *

(If no, please provide more information below)

My child is not fully immunised as: *

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 care are you looking for? *

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? *

Does your child have any additional needs, allergies or intolerances, including any disabilities? *

If Yes please specify *

Is your child fully immunised? *

(If no, please provide more information below)

My child is not fully immunised as: *

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 care are you looking for? *

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? *

Does your child have any additional needs, allergies or intolerances, including any disabilities? *

If Yes please specify *

Is your child fully immunised? *

(If no, please provide more information below)

My child is not fully immunised as: *

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 care are you looking for? *

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? *

Does your child have any additional needs, allergies or intolerances, including any disabilities? *

If Yes please specify *

Is your child fully immunised? *

(If no, please provide more information below)

My child is not fully immunised as: *

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 care are you looking for? *

What school do they attend? *

Are these days flexible? *

Do you have a Preferred Educator *

Yes

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

Purpose of care *

Do you have your own transport? *

How did you hear about Coastwide Family Day Care? *

Any other comments?