Daisies Waiting List Application

If you would like to make a time to visit, please call 4616013 and talk to the head teacher to book a time.

Childs Name *

Childs Name

First Name

Last Name

Date of birth (or expected DOB) *

Date of birth (or expected DOB)

MM

DD

YYYY

Names of parents / key caregiver(s) *

Names of parents / key caregiver(s)

First Name

Last Name

First Name

Last Name

Ages of siblings (if any)

Preferred start date

MM

DD

YYYY

Are you able to flexible about this start date? If so, give date range.

Earliest date

MM

DD

YYYY

Latest date

MM

DD

YYYY

Full Time (5 days) or Part Time? *

Full Time

Part Time

If Part Time, how many days p/wk?

Note: children over 3 must be enrolled a minimum 35 hours per week. Please also let us know your prefered days of the week and any plans on changes over time.

Contact email address (important) *

Home address *

Home phone number

Daytime contact details *

(work phone, cellphone)

Preference for washable or disposable nappies? *

Washable

Disposable

Food preferences or allergies/ intolerances.

Any other medical condition(s), or special needs.

How did you hear about Daisies?

Today's date *

Today's date

MM

DD

YYYY