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    Step 1 of 2

    Child's Name:*


    Date of Birth:


    Parent’s / Guardian’s Name:*


    Parent’s / Guardian’s Address:


    Contact Email:*


    Contact number (Home):


    (Work):


    (Mobile):


    Final Step - Criteria for Placement:

    Are you*
    working full timeworking part timeseeking workstudying or trainingother

    Is your spouse*
    working full timeworking part timeseeking workstudying or trainingother

    Which days do you require care?*
    MonTuesWedThurFri

    Are your days flexible?*
    YesNo

    When do you require your child to commence?


    Does your child have a disability or special need?


    Message


    Please note.

    Completion of the waiting list application does not guarantee your child will be offered placement at this centre. Your child will now be placed on the waiting list and we will contact you when a vacancy occurs.

    ‘If you do not receive confirmation that your application has been received within two working days could you please contact us on 97724700.

    Thank you for submitting your application.

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