Enrolment Enquiry Form Family Day Care

Parent / Guardian Details

Date of Application *

Parent / Guardian First Name *

Parent / Guardian Surname *

Phone Number *

Address *

Street *

City *

State *

Postcode *

Email *

Have you applied for Child Care Subsidy through Centrelink? *

YesNo

If you have not yet applied for Child Care Subsidy (CCS) please contact Centrelink to apply for CCS.

Child Details

Child's Given Name *

Child's Surname *

Child's Date of Birth *

Sex of child *

MaleFemaleOther

Does your child attend school? *

YesNo

School Name

Do you need to add details for another child? *

YesNo

Please enter the details for each additional child

Additional Children's Details *Please include each child's full name and date of birth

Does your child have any medical conditions / allergies / disabilities? *

YesNo

Details of Medical Condition / Allergy / Disability *

Does your child have a current Medical Action Plan? *

YesNo

You will be required to submit a current Medical Action Plan with your child's enrolment paperwork prior to starting care with KELFDC. Medical Action Plans must be reviewed annually by a Registered Medical Practitioner.

Care Expectations

Please specify the hours you require? *

Preferred start date *

Do you already know an educator you would like to send your child to *

YesNo

Please provide the Educator's name *

Suburb Preferences *Please list any suburbs that you are willing to travel to

How will you be travelling to and from care? *

DriveWalkTrainBus

Which train station do you use?

What are your care expectations? (select all that apply)

Close to homeEducator is from my cultural backgroundHome environment / small group settingExperience and qualifications of the educatorEducator provides a quality program Educator provides an engaging indoor/ outdoor environmentEducator takes children on outings / excursionsEducator meets my care needsOther

Other:

Are there any aspects of your child's cultural, ethnic, and / or religious background that you would like us to be aware of?

YesNo

If yes, please provide details

If other, please specify *

Would you like to be placed on the Kids' Early Learning Childcare Centre's waiting list?

YesNo

To join the Kids' Early Learning Child Care Centre's waiting list, please go to www.kidsearlylearning.com.au/Join-our-waiting-list

Is there anything else you want us to know?