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) *

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 *

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

Earliest Date

Latest date

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 *

DD/MM/YYYY format please