Child Registration Form

Please fill out your registration request below as accurately as possible and then 'Submit' it to us and we will contact you as soon as possible.

 *Required field

Which Nursery?*

  

Child’s Details

Child’s Name:*

  
Gender:* Male            Female

Date of birth: (dd/mm/yy)*

 

Address:*

  

Postal Code:*

  

Home telephone number:

 
Email Address:*  

Parent / Carer Details

Mother’s Name:

 

Work Phone:

 

Mobile Phone:

 

Father’s Name:

 

Work Phone:

 

Mobile Phone:

 

Other:

 

Requested Start Date: (dd/mm/yy)      *

Do you require Sessional or Full Time care?*

Full Time Care:           (Monday - Friday, 08.00 - 18.00)

Sessional:                       

If 'sessional', then please tick the required sessions below...

 

Monday

Tuesday

Wednesday

Thursday

Friday

Morning Session

08.00 - 13.00

 

Afternoon Session

13.00 - 18.00