Home Child Care Application Form

If you wish to register for our Home Child Care Program online, please complete and submit the form below.

Additional information and a print version of the forms are available in pdf format here.

Please note that submission of this form does not imply there is a space available for your child. You will be advised of this within four working days after the form is submitted.

Child's Name:	Sex: Female Male
Date of Birth (dd/mm/yyyy):
Home Telephone:
Mother's Name:	Father's Name:
Commencement Date Required (dd/mm/yyyy):
Contact Email Address: