Child Care Inquiry Form

Parent/Guardian Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
E-mail
example@example.com
Contact Number
Address

Street Address

Street Address Line 2

DIstrictCity

Post Code
Is your child currently in child care?

Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Special Needs/ Allergies

Start Date

MonthDayYear
Preferred Drop-off Time

Hour Minutes

AM/PM Option
Preferred Pick-Up Time

Hour Minutes

AM/PM Option

Please check which days your child would require care. Full time positions only - fees still apply for the day(s) your child does not attend. If your child requires care each day, check all boxes.

Rows	Day of the Week
Monday
Tuesday
Wednesday
Thursday
Friday

How many months would you require full-time childcare? If ongoing, please specify.
Should be Empty: