Wait List Application

Step 1 of 2

Program: *

Long Day Care (8 Weeks – 3/4 years)
4yr old Kindergarten (4/5 years)
OSHC (Prep-Grade 6)

Details of the child requiring care

Name: *

First

Last

Date of Birth: *

Gender:

Male
Female

Parents/Guardian Details:

Parent/Guardian 1:

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact number: *

Email *

Parents/Guardian Details:

Parent/Guardian 2:

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact number:

Email:

Name