Kids On Queens Parade Child Care Centre 476 Queens Parade
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1Office Use Only
Ref No: ______
Kids on Queens Parade Child Care Centre &
Registered Kindergarten
476 Queens Parade, Clifton Hill, 3068
Ph: 9489 3405
Celebrating 20 years in business
CCMS Provider#: CCMS_1_6NI_74
2016 WAITING LIST DETAILS
Information about your child:
Family Name: ……………………….…
Date of Birth: ……………… Sex: M … F …
Given Names: …………………………….
Usually called: ………………………………
Home Address: ………………………………………..………………………………………..
Yes … No …
Is the child of Aboriginal and / or Torres Strait Islander descent?
*Is the child fully immunised or on a recognised catch-up schedule? Yes … No …
*If no, does the child have a medical reason not to be vaccinated? Yes … No …
st
Victorian Government has amended the Public Health and Wellbeing Act 2008 so that from 1
January 2016, early childhood
education and care services cannot confirm enrolment of a child unless the parent provides documentation to prove the above.
Information about the child’s parents or guardians
Mother’s Name: _______________________
Father’s Name: ________________________
Address – as per child, or:
Address – as per child, or:
Telephone/s
Telephone/s
(H)
(W)
(H)
(W)
(Mobile)
(Mobile)
Does the child live with the mother?
Does the child live with the father?
Yes…….
No…….
Yes…….
No…….
Preferred email address to be contacted on: _____________________________________________________________
Days that care is required -
: (Operating hours are 6.30 am - 6.30pm.) Please tick
Minimum care available is 2 days per week
days required.
(
•
•
•
•
•
Monday
Tuesday
Wednesday
Thursday
Friday
flexible
•
•
Are you
with the days your child is able to attend? Yes
No
Required start date: _____________
Pre – Kindergarten _____ Toddler _____
Room:
Kindergarten _____
Babies _____
How did you find out about Kids on Queens Parade Child Care Centre?
•
•
•
•
•
•
Recommendation from other
Website
Phone Book
City of Yarra
Walking past
Open Day
Other
__________________________________________________________________
(please specify)
This form will be kept on file for a period of 12 months, unless other arrangements such as our service being contacted by you
to have your name left on the wait list is arranged. If you no longer wish your child's name to be on our wait list due to
alternative arrangements, we ask that you please contact the centre and have your families name removed.
A Booking fee of $80.00 non refundable, applies for all new enrolments, once you have been offered a place at our service.
Please note that enrolments will NOT be processed unless payment of $80.00 accompanies the Enrolment Form. Once you
have been offered a place at our service, the booking fee must be paid within 24hours of a place being offered or your place
will be forfeited. Fees are subject to change.
Please make cheque/money order payable to Kids on Queens Parade Child Care Centre or alternatively:
Direct Deposit Details: BSB #: 633 000, A/C # 136 656 659
Return completed form to: Kids On Queens Parade
Children's Program Waiting List Registrar
476 Queens Parade
Clifton Hill Vic 3068
Ph: 03 9489 3405
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