Application for Admission to the Waiting List

Please use this form to apply for a place on the waiting list. Before filling out this form, please first read the general information on enrolment and the current waiting list. You should also read the fine print.

To avoid confusion between European, US and other date conventions, please enter dates in DD-MMM-YY form. For example, 03-Apr-04 or 23-Sep-98.

Details of Child
Family Name
First Name
Date of Birth
Gender	Male Female
Days Required	Mon Tue Wed Thu Fri
Other Information
Date Place Required
First Parent
Name
Address
Gender	Male Female
Home Phone
Work Phone
Mobile Phone
Email
Place of Work/Study
Second Parent
Name
Address
Gender	Male Female
Home Phone
Work Phone
Mobile Phone
Email
Place of Work/Study
Additional Information
	Other children attending UPCCC
	One or both parents working/studying at ANU
	Both parents working/studying
	Single parent working/studying

Please note the following:

That our acceptance of this form does not constitute a contract to provide a place at the Centre.
Once accepted onto our waiting list, your child's name will be active for a period of 3 months. If you have not secured a place within this time, you will need to contact the Centre to advice your intention to remain on the waiting list or your child's name will be deleted.
You should contact the Centre if your care requirements or circumstances change.
All information in this form is confidential and for Centre use only.
Part-time care will only be offered on a 2 or 3 day basis.