Fillable Ymca Early Learning Centres Waiting List Application Form printable pdf download

Ymca Early Learning Centres Waiting List Application Form

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Services

YMCA Early Learning Centres

Waiting List Application Form

Date of Application:

Date for commencement of care:

YMCA of Canberra operates two Early Learning Centres. Would you accept placement at: (please tick)

 YELC Belconnen: 1 Joy Cummings Place Belconnen

Yes

 YELC Jamison: Bowman St, Macquarie

Yes

Child’s Full Name: _________________________

Date of Birth:

Full Time

Part Time:

Care required (please circle

(please click in box)

Special Considerations: ________________________________________________________________________

Reason care is required (please tick):

Work Related

Study

Other

Parent/Guardian’s Name (1) ______________________________ Date of birth: ________________________

Address: ____________________________________________________________________________________

Phone (h) _______________________ (w) __________________________ (m) __________________________

Email Address

Parent/Guardian’s Name (2) ______________________________ Date of birth: ________________________

Phone (h) _______________________ (w) __________________________ (m) __________________________

Email Address

How did you find out about the centre? ____________________________________________________________

Office Use Only

Contact Date

Follow up

........................................................................................................................................................................................

Please tear off and retain for your record:

Date care required as listed on your form ……………………………..

We will try twice to contact you to offer you a place and if we are unsuccessful we will leave a message. If we

receive no response within 48 hours of the second attempt we will take your child’s name off the waiting list.

If there are any changes in personal details please contact us ASAP to update your information on (02) 6251

1683.

If you have found care elsewhere please contact us so that we can take your child’s name off our list

Please return form to Fax: (02) 6251 1015

Post :YMCA Early Learning

Please return form to Fax: (02) 6242 4439 or Email:

.au

Email: