Shiny Star Waiting list form
Dear Parents & Guardians, Welcome to Shiny Star Play Centre. Thank you for expressing interest in ourcentre as the venue for your child’s before and after school care needs. Please complete the following to ensure your child is secure on our waiting list.
Child's Details
Name:
*
First Name
Last Name
Gender:
*
Male
Femail
Date of Birth:
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Does your child have any additional special needs?
*
No
Other
Parent/Guardian Details
Title:
*
Dr.
Mr.
Mrs.
Ms.
Name:
*
First Name
Last Name
Mobile Number:
*
Format: 0000 000 000.
Suburb:
*
Email:
example@example.com
Booking Details
Proposed Start Date:
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
School Attending:
*
Before School Required:
Monday
Tuesday
Wednseday
Thursday
Friday
After School Required:
Monday
Tuesday
Wednseday
Thursday
Friday
Comments:
Deposit
prev
next
( X )
Deposit
$100.00 AUD
$
100.00
AUD
Total
$0.00 AUD
$
0.00
AUD
Credit Card
Submit
Should be Empty: