Prom Coast (PCCC) - LDC Application Form

Prom Coast Centres for Children - Foster

Long Day Care Registration form
Deferral Form
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
Child's Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Child's Address

Street Address

Street Address Line 2

CityState

Post Code
Care Requirements
When would you like to start?

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
What days of week do you require care (please select all that are possible)?
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?
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?
Parent / Guardian 2

First NameLast Name
Relationship to the child
Parent / Guardian 2 Address
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?
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
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?
Are you working, studying or looking for work?
Additional Information
Does your child have any special needs
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?
Name of support service / agency:
What program type is this application relevant to?
Preference One
Already Paid?
form_name
Should be Empty:

Prom Coast Centres for Children - Foster

Care Requirements

Parent / Guardian Details

Enrolment & Immunisations

Priority of Access

Additional Information