Blackstone Waiting List Form - Building Futures Montessori Daycare

Blackstone Waiting List

Part 1

Parent / Guardian One

First Names

Family Name

Date of Birth

Phone

Relationship to child/ren

Street Address

Suburb

Postcode

Occupation

CRN (if known)

Due to government regulations, priority of places must be allocated according to a list of needs. As these are a "rough" order of priority, please tick only one box.

Child/ren are at risk of abuse and being referred by State Government (Highest Priority/ ONE)

Both (or sole parent) are working, seeking work, studying or training. (Priority TWO)

A parent of child in the family has a disability. (Priority THREE)

A parent (not working) has been encouraged by a doctor or counsellor to seek respite care (Priority THREE)

There are number of young children in the home (Priority THREE)

The family is seeking and educational program for a young child. (Priority THREE)

How did you find out about Building Futures Montessori ?

Add Another Parent or Guardian ?

Yes

Parent / Guardian Two

Does this Parent or Guardian live with the child/ren ?

Yes

First Names

Family Name

Date of Birth

Phone

Relationship to child/ren

Occupation

Street Address

Suburb

Postcode

How often is the child/ren at this address?

Is this Parent / Guardian authorised to collect ?

Yes

Part 2

How many children would you like to enrol?

Child One

First Names

Family Name

Gender of child

Male

Female

Date of Birth

Days Required

CRN (if known)

Preferred Start Date

Child Two

First Names

Family Name

Gender of child

Male

Female

Date of Birth

Days Required

CRN (if known)

Preferred Start Date

Child Three

First Names

Family Name

Gender of child

Male

Female

Date of Birth

Days Required

CRN (if known)

Preferred Start Date