Early Learning Waiting List Form

Date of Application*

Days Required*

Any Days
Monday
Tuesday
Wednesday
Thursday
Friday

Select Anglicare Location*

Preferred Start Date*

Child's Information

Child's Name*

First Last

Child's Date of Birth*

Address*

Street Address Suburb/ Town State Postcode

Is your child of Aboriginal or Torres Strait Islander descent?*

Yes
No

Languages Spoken at Home*

Parent's Information

Parent's Name*

First Last

Mobile Phone Number*

Email*

Employment Information*

Please select from the list below. If employed, please provide the name of your employer in the space below.

Employed Full-time
Employed Part-time
Not Currently Employed
Studying

Employer Name

Alternative Phone Number*

Please provide an secondary phone number that will help us contact you during daytime hours. Eg. home landline or work phone number.

What option best describes your family status?*

Two-parent family
Sole parent
Shared custody
Other

If other, please describe

Second Parent's Information

Please complete the following details for the child's 2nd parent (if applicable).

Parent's Name

First Last

Mobile Phone Number*

Employment Information

Please select from the list below. If employed, please provide the name of your employer in the space below.

Employed Full-time
Employed Part-time
Not Currently Employed
Studying

Employer Name

Alternative Phone Number

Please provide an secondary phone number that will help us contact you during daytime hours. Eg. home landline or work phone number.

Terms

Terms*

I understand that submitting this form places my child on the waiting list for enrolment at the Anglicare centre I have selected. I understand that my child being placed on the waiting list does not guarantee a place by the date I stated as my preference. Places are offered when suitable vacancies arise. I understand that if my child has not been placed at the centre after 6 months on the waiting list, and I have not contacted Anglicare, my child will be removed from the waiting list.

Yes, I understand