Wait List Rego Wait List Registration Parent/Guardian First Name * Surname * Phone * Email * Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Priority of Access In accordance with the Australian Government's Priority of Access Guidelines, please mark the following if applicable: Priority of Access Child (or children) at risk of serious abuse or neglect Children of a single parent who satisfies, or of parents who both satisfy, the work/training/study test under Section 14 of the 'A New Tax System (Family Assistance) Act 1999' Child Child First Name * Child Surname * Date of Birth * Medical Details Medical Condition My child has a medical condition and/or additional needs. If so, Please provide details of medical conditions and needs. Preferences When would you like your child to commence care? Commencement Requires care as soon as possible Requires care from a specified date If date is to be specified, which date? How many days of care per week do you require for this child? Please select12345 Monday N/A12345 Tuesday N/A12345 Wednesday N/A12345 Thursday N/A12345 Friday N/A12345 Do you want your children to attend on the same days? Yes It doesn't matter Other Children If there is more than one child, please enter their details here First Name (Sibling 2) Surname (Sibling 2) Date of birth (or expected due date) (Sibling 2) Medical Details (Sibling 2) Medical Condition My child has a medical condition and/or additional needs. (Sibling 2) If so, Please provide details of medical conditions and needs. Additional Information Is there anything else we need to know? Captcha Submit If you are human, leave this field blank.
