Little Joey’s Pre-School

ABN 15153292338 Approval: CSSC1001787

Child’s Surname:
Child’s Given Names:
Sex:	MaleFemale
Start Date:
Child’s date of birth:
Place of birth:
Child resides with:
Ethnicity:
Languages spoken:

Proposed Commencement date:

Are there any court orders affecting your child?: YesNo

(photo copies must be provided and all staff must be made aware of the circumstances)

Booking details:

TIMES	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY

A $50.00 non-refundable administration fee is payable to secure a position.

2 weeks notice must be given in writing if you wish to close your child’s enrolment.

Your child’s account must be paid in full on or before their final day of attendance.

Child Care Benefit And family Information:

Have you been assessed for the Child Care Subsidy (CCS) with Centrelink? YESNO

Do you have other children attending approved child care services/family day care or outside school hours care programs and thus wish to claim the increased child care percentage?YESNO

Which parent is registered to claim Child Care Benefit?

Family CRN:

Child CRN:

	Parent / Guardian 1	Parent / Guardian 2
Surname
Given Names
Date of Birth
Relationship to Child
Home Address
Occupation
Home phone
Work phone
Mobile phone
Email contact