APPLICATION FOR WAIT LIST

(This is not a guarantee of enrolment)

Name of Child: ______Date of Application: ______

Birth date: ______Male Female Language(s) Spoken at Home: ______

Do you have a sibling currently on the waitlist No Yes if yes, Name: ______

Parent 1 / Parent 2
Name:______
Address:______
______P/Code: ______
Telephone Home:______
Telephone Business: ______
Mobile: ______
Occupation:______
Email Address: ______
Work Details: please tick () one of the following:
Working: Mon Tue Wed Thu Fri
Casual Parental Leave
Studying: Mon Tue Wed Thu Fri
To meet government guidelines, evidence of work/study status will be required on enrolment. / Name:______
Address:______
______P/Code: ______
Telephone Home:______
Telephone Business: ______
Mobile: ______
Occupation:______
Email Address: ______
Work Details: please tick () one of the following:
Working: Mon Tue Wed Thu Fri
Casual Parental Leave
Studying: Mon Tue Wed Thu Fri
To meet government guidelines, evidence of work/study status will be required on enrolment.

Operating hours are 7.00am - 6.00pm. The minimum care available is 2 days per week.

Please tick () days preferred.

Monday Tuesday Wednesday Thursday Friday

Are you flexible with the days your child is able to attend? Yes No

Will you accept to start less days when we offer you the initial placement? Yes No

(Please note: Full time care is only available to parents working, looking for work or studying in view of employment)

During what hours do you require care? ______

If there is a place available, I wish to start my child from: ______

Room required in preferred year: 0-3 years ( Nursery) 3-5 years (Pre-School)

Do you or your child suffer from a continuing disability or incapacity? No Yes

If Yes, details: ______

Does your child suffer from any allergies? No Yes

If Yes, details: ______

Does your child have any special needs/ challenging behaviours? No Yes

If Yes, details: ______

PRIORITY OF ACCESS GUIDELINES FOR CENTRE BASED LONG DAY CARE SERVICE

SET BY COMMONWEALTH GOVERNMENT 2000

FIRST PRIORITY A child at risk of serious abuse or neglect

SECOND PRIORITY A child of a single parent who satisfies, or parents who both satisfy the work/training/study test under section 14 of the Family Assistance Act

THIRD PRIORITY Any other child

Within these main categories, priority should also be given to children listed below. To allow us to determine your child(ren)s

priority position on our waitlist, please tick the following categories if they apply to your child. If you require an explanation of

any of the categories below, please call the centre.

children in Aboriginal and Torres Straight Islander families

children in families which include a disabled person

children in families on low income. (Health Care Card to be sighted)

children in families with a non-English speaking background

children in socially isolated families

children of single parents

If you have ticked one of the boxes, please provide details below:

______

______

Within these guidelines, priority of access is also given to families who have current/past children at the centre.

Have any of your children attended Maroubra Junction Early Education Centre before? No Yes If Yes:

Child's Name: ______Year of Enrolment: ______

I acknowledge that all information supplied on this form is correct at the time of signing.

Signed: ______Date:______

How did you find out about Maroubra Junction Early Education Centre? Please tick:

Recommendation Local Government Directory Phone Book Website Other ______

Return completed form to: The Director, Maroubra Junction Early Education Centre, 1/142 Maroubra Road, Maroubra, NSW, 2035 or alternatively scan the wait the list form and email to Privacy Note: The personal information that you have provided is for the Centres purposes only and will be viewed only by staff at Maroubra Junction Early Education Centre.