Prom Coast - LDC Application Form

Prom Coast Centres for Children - Foster

Long Day Care Registration form
Deferral Form

Yes
If you would like to place your child on the waitlist for long day care at a Prom Coast Centre Foster please complete the following form.

Please Note: To access 3 and 4 Year Old Kindergarten funding as part of the long day care program offerred at Foster you will need to make an application directly with South Gippsland Shire Council.

If your child is enrolled in 3 or 4 year old kindergarten and already attending Toora, Fish Creek or Welshpool Kindergarten please contact us directly to complete your Long Day Care application: admin@pccc.net.au or 5683 9800
Please let us know your updated care preferences by completing and submitting this form.
Child's Name*

First NameLast Name
Gender*

MaleFemaleUnspecified
Child's Date of Birth*

DayMonthYear
Child's Address*

Street Address

Street Address Line 2

CityState

Post Code
Care Requirements
When would you like to start?*

DayMonthYear
Date
What days of week do you require care (please select all that are possible)?*

MondayTuesdayWednesdsayThursdayFriday
How many days of care do you require?*
Year*
Do you want to access the funded integrated kindergarten program for eligible 3 year olds and 4 year olds?*

YesNo
All children are eligible to receive 15 hours of funded kindergarten for 2 years prior to attending school.
Please indicate whether your child will be accessing their first or second year of funded kindergarten in {service-preferences_care-period}. *
Parent / Guardian Details
Parent / Guardian 1*

First NameLast Name
Relationship to the child*
Address*

Street Address

Street Address Line 2

CityState

Post Code
Phone Number*
Email*
Please Note: You will be notified of all correspondence via email
Would you like to add a second parent / guardian?*

YesNo
Parent / Guardian 2*

First NameLast Name
Relationship to the child*
Parent / Guardian 2 Address*

Same as parent / guardian 1Different to parent / guardian 1
Address*

Street Address

Street Address Line 2

CityState

Post Code
Phone Number*
Email*
Please Note: You will be notified of all correspondence via email
Enrolment & Immunisations
The Government’s No Jab No Play laws require all children to be age-appropriately immunised before enrolment can be confirmed. Further information on immunisation requirements for enrolment in early childhood services is available on the State Government's Better Health Channel at www.betterhealth.vic.gov.au/campaigns/no-jab-no-play
Are your child's immunisation up to date?*

YesNo
Priority of Access
Allocation of available places is made in accordance with the Australian Government's Priority of Access Guidelines and other information gathered from you as part of this waitlist process. Please answer the following questions to ensure we can assess your waitlist accordingly.
Please select any of these that apply*

Aboriginal and Torres Strait IslanderFamily includes a disabled personIs the child at riskParent 1: Care required for workingParent 2: Care required for workingParent 1: Care required for studyParent 2: Care required for studyCare required for socialisationSingle parent familyNone of the above
Please confirm Parent 1 place of work or study including a contact number and address to verify this.*

Please include the days you work and / or study.0/125
Please confirm Parent 2 place of work or study including a contact number and address to verify this.*

Please include the days you work and / or study.0/125
Parent 1 + Parent 2 - place of work or study including a contact number and address to verify this.

0/250
Is this child or family known to child protection or currently involved with Orange Door?*

YesNo
Are you working, studying or looking for work?*

YesNo
Additional Information
Does your child have any special needs*

YesNo
If yes, please specify:*
You are encouraged to discuss your child's needs with the educator when your child's place is confirmed.
Is your child registered with a specific Support service / agency?*

YesNo
Name of support service / agency:
What program type is this application relevant to?*
Preference One*
Already Paid?

Yes
form_name
Should be Empty:

Prom Coast Centres for Children - Foster

Care Requirements

Parent / Guardian Details

Enrolment & Immunisations

Priority of Access

Additional Information