DATE: ______

CHILD’S NAME: ______

EXPECTED/DATE OF BIRTH: ______

DAY’S OF CARE REQUIRED:

____MONDAY _____TUESDAY ____WEDNESDAY ____ THURSDAY ___FRIDAY

ARE THESE DAYS FLEXIBLE? YES/NO

PREFFERED START DATE (MONTH/YEAR):______

PARENT 1 DETAIL: PARENT 2 DETAILS:

NAME: ______NAME: ______

ADDRESS: ______ADDRESS: ______

______

______

HOME PHONE: ______HOME PHONE: ______

MOBILE: ______MOBILE: ______

WORK PHONE: ______WORK PHONE: ______

EMAIL: ______EMAIL: ______

Please indicate if any of the following priority of access circumstances applies to your family.

( ) Priority 1- A child at risk of serious abuse and neglect.

( ) Priority 2- A child of a single parent who satisfies, or of a parent who both satisfy the work training, study test.

( ) Priority 3- Any other child.

( ) Two parent family ( ) Single parent family ( ) Grandparent/s with legal guardianship

Working Parents:

( ) One/Both working full time ( ) One working full time/one part time ( ) both part time

( ) One part time ( ) Seeking employment/studying ( ) Home duties

Within these main categories, priority should also be given to the following children

( ) Children in Aboriginal and Torres Strait Islander families.

( ) Children in families which include a disabled person.

( ) Children in families which include an individual whose adjusted taxable income does not exceed the lower income threshold or who or whose partner are on income support.

( ) Children in socially isolated families.

( ) Children of single parent families.

Note: It is a condition of approval for Child Care Benefit (CCB) purposes that a service must comply with Family Assistance Law.

The priority access guidelines must be used by approved services to allocate available child care places where there are more families requiring care than places available.

When filling vacant places, a service must fill spaces according to the priorities that are detailed above.

(Last updated July 2012- from the DEEWR handbook page 74)

Does your child have any known allergies? YES/NO

If yes, please identify them and any current treatment needed for them:

______

Does your child have a disability? / additional needs? YES/NO

If so, please specify and provide details

______

Please advise Betty Spears Child Care Centre should any of the above details change. We also advise you to contact the centre 3 months before you require care to see how your application is proceeding. By signing below you are acknowledging understanding of the priority of access information. In addition you are acknowledging that you are aware of the need to keep information updated and stay in regular contact with the centre while on the waiting list.

Signed: ______Date: ______

Office Use Only

Parent Contacted / Comments / Date / Staff

Offered Place: Starting:

Days Offered: Days:

Date: Date:

Betty Spears Child Care Centre ABN 57 003 143 593

1A Gannon Street Tempe NSW 2044, Phone: 02 9558 8350

Email:

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