Family Day Care Pre-Enrolment Form

Child 1

Primary Contact First Name

Primary Contact Last Name

Primary Contact Phone Number

Primary Contact Email Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Preferred Start Date

Preferred Days Required

Preferred Location

Child First Name

Child Last Name

Child Country of Birth

Ethnic Group (i.e. Australian)

Primary Language

Date of Birth

Indigenous Status

Not Aboriginal or Torres Strait Islander

Aboriginal and Torres Strait Islander

Torres Strait Islander

Aboriginal

Priority of Access

At risk/Referral

Work Related/Studying

Parent/Child Disability

Respite

None of the above

Child 2 (if applicable)

Primary Contact First Name

Primary Contact Last Name

Primary Contact Email Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Preferred Start Date

Preferred Days Required

Preferred Location

Child First Name

Child Last Name

Child Country of Birth

Ethnic Group (i.e. Australian)

Primary Language

Date of Birth

Indigenous Status

Not Aboriginal or Torres Strait Islander

Aboriginal and Torres Strait Islander

Torres Strait Islander

Aboriginal

Priority of Access

At risk/referral

Work related/studying

Parent/Child disability

Respite

None of the above

Privacy Statement

Personal information collected on this form will be used by Council’s Early Years Departments to process your child's pre-enrolment into Council's Family Day Care Program. Council may disclose your information to other internal departments to be processeed and will not be disclosed to any external party without your consent, unless required or authorised by law. If you do not provide us with all required information Council reserves the right to remove your application from the enrolment process. You have the right to access your personal information and make any necessary corrections. If you have any queries or wish to gain access to amend your information please contact Golden Plains Shire’s Privacy Officer on (03) 5220 7111 or [email protected].

For further information, please contact [email protected]

Family Day Care Pre-Enrolment Form

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