Waiting List Application Form

Monash Children's Centre Waiting List Application Form

Applicant Details

Parent/Guardian Name *

Address *

Post Code *

Primary Phone *

Secondary Phone

Primary Email *

Secondary Email

Status of Applicant Monash Student
Monash Staff
Community
*

Faculty *

Student Number *

Faculty *

Staff Number *

Child Details

Child's Name *

Child's Date of Birth OR Expected Due Date *

Gender Male
Female
*

Childcare Details

Days Required *

Preferred Days Monday
Tuesday
Wednesday
Thursday
Friday
*

Flexible on Days

Start Date *

Does your child have a sibling at Monash Children's Centre? No
Yes

Child's Name *

Child's D.O.B *

Does your child have a sibling on the Monash Children's Centre waiting list? No
Yes

Child's Name *

Child's D.O.B *

Does your child have a sibling who previoulsy attended Monash Children's Centre? No
Yes

Child's Name *

Year Finished *

I am aware that my child's immunisations must be up to date at the commencement of their care at Monash Children's Centre and that I will be required to provide an Immunisation History Statement from the Australian Childhood Immunisation Register (ACIR.)

More information on this can be found at: https://www2.health.vic.gov.au/Api/downloadmedia/%7B9DB7CA8F-488E-48DE-BBBB-F08D2A17959C%7D

Immunisation Agreement *

I am aware that it is my responsibility to ensure that my contact details on this waiting list form are current and that if I do not respond to email or phone correspondence I will be removed from the waiting list.

Acknowledge *

Security

Thank you for your expression of interest in our centre.
We have received your application and placed it on our waiting list.
We will be in contact with you when a position matching your criteria arises.

Kind Regards
Julie, Angie and Natasha