Preference & Registration - GreythornECC

Deferral Form

Yes

Waitlist Validation

Program Type

Child Details

Child's Name*

First nameLast name

Gender*

MaleFemaleOther

Child's date of birth*

Parent's Details

Parent / Guardian 1*

First nameLast name

Phone Number*

Email*

Please note: you will be notified of all correspondence via email. This email will be used for all future correspondence unless otherwise advised.

Address

Street Address

Street Address Line 2

SuburbState

Postcode

{serviceallocation_care-period} Care Requirements

When would you like to access care for this child?*

Date

Waitlist validation year

What year does this registration apply for?*

Age at Start Date

How many days of care do you require?*

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

What program type is this application relevant to? *

Which group will this child be allocated to?*

Access Priority Questions

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.

Is this child at risk of serious abuse or neglect*

YesNo

Do both parents (or in the case of single parent family, does the parent) satisfy, the work/training/study test under Section 14 of the 'A New Tax System (Family Assistance) Act 1999*

YesNo

Does this child have a medical condition or any additional needs*

YesNo

Please provide details of the medical conditions and needs*

0/250

Does this child have a sibling that has previously or currently attends GreythornECC*

YesNo

Please provide details of prior connection*

Waitlist Fee Payment

This is a non refundable $20.00 fee payable to the centre per child per waitlist application.

GreythornECC Waitlist Application Fee*

GECC waitlist application fee$20.00AUD

Total $0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Would you like to send a confirmation email for this change?*

Payment Name

Amount

Payment Type

Payment Reference Number

alreadyPaid

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