Waiting List Application Form
(This is not a guarantee of enrolment)
The personal information requested is being collected by Bridge Road Early Learning Centre for wait listing applications and will be used solely by the Centre for that primary purpose or directly related purposes.
Name of Centre:
Date of Application:
Children requiring care:
NameMale/FemaleDate of Birth
Parent Details:
Parent 1Parent 2
Full Name:Number & Street:
Suburb:
Postcode:
Home Phone No.
Work Phone No.
Mobile Phone No.
E-mail address:
Work Details: (Please circle the following)
Parent 1:
Working:Full timePart time:CasualParental/Maternity Leave
Studying:Full timePart time:CasualParental/Maternity Leave
Parent 2:
Working:Full timePart time:CasualParental/Maternity Leave
Studying:Full timePart time:CasualParental/Maternity Leave
Care Requirement: (Operating hours are 6:30 am – 6:30pm)
Please circle days required.
Monday TuesdayWednesdayThursdayFriday
Are you flexible with the days your child is able to attend?YesNo
When is this place required? Month: ……………………
Year: ………………………
Priority of access:
In allocating child care places to families; we will endeavour to comply with the Department of Family and Community Services priority of access guidelines.
1st priority:Children at risk of serious abuse or neglect
2nd priority:A child of a single parent who satisfies, or parents who are both working/studying/training.
3rd priority: Any other child.
To allow us to determine your child’s priority position, please tick the following categories if they apply to your child:
o Children in Aboriginal & Torres Straight Islander families;
o Children in families that include a disabled person;
o Children of single parents
o Children in families with a non- English speaking background
o Children in socially isolated families
Allergies:
………………………………………………………………………….
………………………………………………………………………….
Special Needs:
…………………………………………………………………………
…………………………………………………………………………
The applicant understands that the personal information is for the above purposes only. Requests for access and correction should be made to the Director Anna Moutzouris on 9429 2944.
I acknowledge that all information supplied on this form is correct at the time of signing.
Signed: …………………………….. Date: ………………………..