Rachel's Place Childcare Centre - Nurturing Childcare in West End

Thank you for your interest in Rachel’s Place Children’s Centre. Completion of this form places your child’s name on the waiting list but does not guarantee a place at the centre. You will receive a confirmation letter to confirm your place on the waiting list and will be contacted 6 monthly to renew your interest in a place. The information provided is confidential and used for the purposes of placing your child on a waiting list.

Childcare Requirements

Required start date*

Preferred Days*

If you require less than 5 days per week are you prepared to accept any days that are allocated?*

Yes
No

Does a sibling attend the centre?*

Yes
No

Child's Details

Name*

Given Family/Surname

Date of birth*

Gender*

Male
Female

Address*

Street Address Suburb State Post Code

Is your child fully immunised?*

Yes
No

Parent/Guardian 1

Name*

Given Family/Surname

Relationship to child*

Phone (Mobile)*

Phone (Home/Work)

Email*

Language spoken at home*

Interpreter required

Yes
No

Parent/Guardian 2

Name

Given Family/Surname

Relationship to child

Phone (Mobile)

Phone (Home/Work)

Email

Language spoken at home

Interpreter required

Yes
No

Priority of Access

The following questions are necessary to define your priority rating as determined by the Federal Government. If you answer yes to any of the following you may be required to provide proof under Section 14 of the Family Assistance Act.

Priority*

Priority 1: A child at risk of serious abuse or neglect
Priority 2: A child of a single parent who satisfies, or of parents who both satisfy the work/training/study test under section 14 of the family assistance Act (eligible hours for CCB on the child’s Income Assessment Notice will tell you this.)
Priority 3: Any other child

Children In

Aboriginal and Torres Strait Islander Families
A family which includes a person with a disability
Families on lower incomes (100% CCB)
Families with non- English speaking background
A single parent family

Does your child have a diagnosed need or disability*

Yes
No

Does your child attend or access any specialist services*

Yes
No

Specialist services your child attends

Form Agreement

Name of person submitting form*

By entering my full name and pressing submit I am agreeing that I understand the Priority of access conditions outline. I also agree to notify the centre should my circumstances change.

CAPTCHA

Waiting List Application

Childcare Requirements

Child's Details

Parent/Guardian 1

Parent/Guardian 2

Priority of Access

Form Agreement

Rachel’s Place Child Care Centre

Contact