Enrolment Step 1 - Coastwide Child and Family Services - 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 *

Thank you for sharing this information. We are committed to finding the right educator for your family. The right educator will have the training, knowledge and environment to support your child to transition well and thrive whilst in care.

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 *

Thank you for sharing this information. We are committed to finding the right educator for your family. The right educator will have the training, knowledge and environment to support your child to transition well and thrive whilst in care.

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 *

Thank you for sharing this information. We are committed to finding the right educator for your family. The right educator will have the training, knowledge and environment to support your child to transition well and thrive whilst in care.

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 *

Thank you for sharing this information. We are committed to finding the right educator for your family. The right educator will have the training, knowledge and environment to support your child to transition well and thrive whilst in care.

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 selected your preferred suburb(s), where Suburb Preference 1 is your preferred location

Suburb Preference 1

Suburb Preference 2

Suburb Preference 3

Would you like to consider surrounding areas/suburbs?

Yes please

No thank you

Purpose of care *

Do you have your own transport? *

How did you hear about Coastwide Family Day Care? *

Any other comments?

I acknowledge that the personal information provided on this form is collected, stored and shared for the purpose of enrolling my child/children with Coastwide Family Day Care (CFDC), an education and care service sponsored by Coastwide Child and Family Services (CCFS). Access to this personal information is limited to CCFS staff and other authorised persons. Supply of personal information is mandatory and non-supply may cause delay or prevent the processing of this request. We acknowledge that personal information collected by CCFS will be used, stored and accessed in accordance with the Commonwealth Privacy Act 1988 - Privacy Amendment 2000. *

Yes

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: