Fawkner Park Application Form

Deferral Form

Yes

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

Gender

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

Care Requirements

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

Date

What year does this registration apply for?*

Age at Start Date

Please provide your care requirements for {validationYear}.

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? *

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 family have a sibling currently attending Fawkner Park Children's Centre*

YesNo

Please provide details of prior connection*

FPCC support families who live or work in the City of Melbourne by offering places where possible to children whose parent(s)/guardian(s) live and/or work or study within the South Yarra, St Kilda Rd, Southbank or CBD boundaries of the City of Melbourne

Does either parent / guardian LIVE AND WORK or STUDY within the City of Melbourne?*

YesNo

Does either parent LIVE (not work or study) within the City of Melbourne?*

YesNo

Does either parent WORK or STUDY (but not live) within the City of Melbourne?*

YesNo

child_proximity

YesNo

Please provide details of Work / Study of Home address*

Waitlist Fee Payment

This is a non refundable $53.30 fee payable to the centre per child per waitlist application and does not guarantee an offer of a place.

Fawkner Park Children's Centre

Fawkner Park waitlist application fee$53.30AUD

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?

alreadyPaid

waitlistValidation

Existing Enrolled

Todays date

Date

Validation Year

Payment Name

Amount

Payment Type

Payment Reference Number

Suppress Notifications

Fawkner Park Children's Centre & Kindergarten