GECC Child care application form

Child Details

Male Female

Please note: We cannot accept applications for unborn children

Family Details

Parent 1

Male Female

Home Address:

Click here if this parent's address details are the same as the child's address details

Work Phone:

Mobile Phone:

Single parent: Yes No

Healthcare Card Holder: Yes No

Include 2nd Parent/Guardian details

Parent 2

Male Female

Home Address:

Click here if this parent's address details are the same as the child's address details

Work Phone:

Mobile Phone:

Priority of Access

Please tick one of the following reasons for requiring care:
Work/Study Other
Does a member of your family have any disability?:
Yes No
Are you or your child an Aboriginal or Torres Strait Islander?:
Do you have a child or children currently enrolled in a Council Early Learning Centre?:
Yes No
Do you live or work or study within the City of Glen Eira?:
Yes No

Early Learning Centre

Date that care is required to commence:
Please number in order of preference which centre/s you wish to be considered for (at least one must be selected):
Carnegie Caulfield Murrumbeena
Days you require (please select):

Monday

Tuesday

Wednesday

Thursday

Friday
Can these days be flexible?:
Yes No
Minimum number of days you would accept:

Effective 1 January 2016 before enrolling a child into any early childhood service parent/guardians will need to ensure the child/ren are fully vaccinated for their age. Conscientious objection is no longer deemed an exemption under the No Jab, No Play legislation. Non-immunised children cannot be enrolled into Council's Early Learning Centres.

I declare the above information to be true and correct

The personal information requested is required primarily for the provision of the child care service referred to on this form and will only be shared with those directly responsible for providing that service. If you do not provide the information, we may not be able to deliver the service. If you would like to know more about privacy at Glen Eira City Council, including your right to seek access to any information collected on this form, please see Council’s privacy policy at www.gleneira.vic.gov.au or contact Council’s privacy officer on 03 9524 3333

I have read and understood the information privacy statement outlined above.

Tick this box if you would like to register another child after submitting this application