Waiting List

Child's Name M F
Child's LAST NAME Child's First Name
Address
Contact Email:
Mother's Name: Father's Name:
Address (if different from above) Address (if different from above)
Phone: Home Phone: Home
Mobile: Mobile:
Email (if different from above): Email (if different from above):
Phone: Work Phone: Work
Occupation Occupation
Days of Work M Tu W Th F Days of Work M Tu W Th F
M Tu W Th F

Yes, I would be happy with whatever days are available.
No, I specifically require the days circled above.

Alunga Children's Centre - Albion Park Rail
Clipper Road Children's Centre - Nowra
Cullunghutti Early Learning Centre - Nowra
Hospital Hill Preschool and Occasional Care Centre - Wollongong
Jerry Bailey Children's Centre - Shoalhaven Heads
Keiraview Children's Centre - Wollongong
Sanctuary Point Children's Centre - Sanctuary Point
Short Street Preschool and Occasional Care Centre - Corrimal
Smith Street Children's Centre - Wollongong
The Basin Preschool - Sanctuary Point
Wallaroo Children's Centre - Shellharbour
Warilla Preschool and Occasional Care Centre - Warilla
As soon as possible
PRIORITY 1
Is the child at risk of serious abuse or neglect? Yes No If you answer YES you will be required to provide documentation of this.
PRIORITY 2
Yes No If you answer YES you will be required to provide proof of employment when your child is accepted for enrolment.
Yes No If you answer YES you will be required to provide proof of employment when your child is accepted for enrolment.
Yes No If you answer YES you will be required to provide proof of enrolment in an approved course.
Yes No If you answer YES you will be required to provide written proof of your attempts to obtain employment. (Eg, registration with Centrelink) when your child is accepted for enrolment.
PRIORITY 3
Yes No
Yes No
Yes No
Yes No

I understand the priority of access conditions outlined above and agree to notify the centre should my circumstances change.
Aboriginal Torres Strait South Sea Islander?
Yes No
Does your child have: If yes please provide details
Yes No
Yes No
Yes No
Yes No
Yes No
Sibling on waiting list
First Name Surname DOB
Additional Comments
MARKETING INFORMATION
Please indicate how you found out about the service (optional)
Recommended by a friend Location Word of mouth Website
Child Care Hotline Telephone Book Other

I understand that submission of this form does not guarantee a place in my chosen centre.
(IACC staff will be in contact if further information is required or when a place is available.)