Details of person completing this form

Email Address

Phone Number

Which group or groups does your child/children currently qualify for?

Booking Preferences

Please indicate your intentions regarding bookings

Please indicate the level of importance you place on the following criteria in Early Childhood Services

CHILD DETAILS - Please complete the following for your ELDEST child

Eldest child's name

Date of Birth (eldest child)

Preferred number of booked days (indication only)

SCHOOL AGE CARE - Primary School currently attended by your child

LONG DAY CARE CHILD - Primary School your child will attend (if known)

LONG DAY CARE CHILD - Is your child currently in child care or family day care?

Does your child have any special requirements? If YES, please specify (eg. nut allergy, developmental delay)

Other comments (if relevant)

CHILD DETAILS - Please complete the following for your SECOND ELDEST child (or scroll down to Submit)

Second eldest child's name

Date of Birth (second eldest child)

Preferred number of booked days (indication only)

SCHOOL AGE CARE - Primary School currently attended by your child

LONG DAY CARE CHILD - Primary School your child will attend (if known)

LONG DAY CARE CHILD - Is your child currently in child care or family day care?

Does your child have any special requirements? If YES, please specify (eg. nut allergy, developmental delay)

Other comments (if relevant)

CHILD DETAILS - Please complete the following for your THIRD ELDEST child (or scroll down to Submit)

Third eldest child's name

Date of Birth (third eldest child)

Preferred number of booked days (indication only)

SCHOOL AGE CARE - Primary School currently attended by your child

LONG DAY CARE CHILD - Primary School your child will attend (if known)

LONG DAY CARE CHILD - Is your child currently in child care or family day care?

Does your child have any special requirements? If YES, please specify (eg. nut allergy, developmental delay)

Other comments (if relevant)

If you have more than 3 children who are eligible to attend Archer Street Child Care Centre then please list their details here or scroll down to SUBMIT FORM