Family Day Care Enrolment Form

Please complete the online Family Day Care placement application form below, or if you would prefer to provide these details offline, please download and print the following form. Please note that completing a placement application form is the first step in helping Kath Dickson Family Centre find a placement for your child which will be subject to availability.

Please note places are subject to availability. By completing this form you are not guaranteed a placement for your child.

Enrolment - Family (621 KB)

After you have completed the form, you may:

Email it to: info@kdfc.com.au
Or deliver it in person to your local office. Please visit the contacts section for details on your local office.

Online Placement Application Form

* Required

Care to Start: *

Care Required In (Suburb/Town): *

Title
DR MISS MR MRS MS

First Name *

Last Name *

Parents DOB *

Home Address *

Suburb *

Post Code *

Work/Study Address

Work/Study Suburb

Work/Study Post Code

Home Phone Number *

Work Phone Number

Cell Phone Number

Email Address *

Child 1: Name *

Child 1: D.O.B. *

Child 1: Name of Prep/School Attending (if applicable)

Child 1: Travel Requirements (if applicable). My child will need to be:
-- Please select -- Dropped off to school or home Picked up from school or home Both dropped off and picked up from school or home

Child 1: Hours of Care Required (Helpful Hint > Times Care is required outside parent Work Hours) *

Child 2: Name

Child 2: D.O.B.

Child 2: Name of Prep/School Attending (if applicable)

Child 2: Travel Requirements (if applicable). My child will need to be:
-- Please select -- Dropped off to school or home Picked up from school or home Both dropped off and picked up from school or home

Child 2: Days and Hours of Care Required (Helpful Hint: Times Care is required outside parent Work Hours)

Child 3: Name

Child 3: D.O.B.

Child 3: Name of Prep/School Attending (if applicable)

Child 3: Travel Requirements (if applicable). My child will need to be:
-- Please select -- Dropped off to school or home Picked up from school or home Both dropped off and picked up from school or home

Child 3: Days and Hours of Care Required (Helpful Hint: Times Care is required outside parent Work Hours)

Child 4: Name

Child 4: D.O.B.

Child 4: Name of Prep/School Attending (if applicable)

Child 4: Travel Requirements (if applicable). My child will need to be:
-- Please select -- Dropped off to school or home Picked up from school or home Both dropped off and picked up from school or home

Child 4: Days and Hours of Care Required (Helpful Hint: Times Care is required outside parent Work Hours)

Child 5: Name

Child 5: D.O.B.

Child 5: Name of Prep/School Attending (if applicable)

Child 5: Travel Requirements (if applicable). My child will need to be:
-- Please select -- Dropped off to school or home Picked up from school or home Both dropped off and picked up from school or home

Child 5: Days and Hours of Care Required (Helpful Hint: Times Care is required outside parent Work Hours)

Do any of your children have special care requirements? *
Yes
No

If yes, please provide details

Useful information? (Other Information)

Have you used Family Day Care before?
No
City
Regional
TV
Other Scheme

If 'Other Scheme' please specify

Are you prepared to travel? *
Yes
No

If yes, how far?
-- Please select -- 5km radius 10km radius 15km+ radius

Are you happy if the educator has pets in the home? *
Yes
No

Enter Word Verification in box below *

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