CHILD'S INFORMATION *

Child's Name

First Name

Last Name

Date Of Birth *

MM

DD

YYYY

Child's Gender *

Female

Male

Does your child have any additional needs or require extra support? *

Yes

No

Family Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

PARENT/GUARDIAN INFORMATION *

Name of Parent 1

First Name

Last Name

Are you currently: *

Working

Seeking Work

Studying

Mobile *

(###)

###

####

Name of Parent 2 *

First Name

Last Name

Are you currently? *

Working

Seeking Work

Studying

Mobile *

(###)

###

####

ATTENDANCE INFORMATION *

Preferred Start Date

MM

DD

YYYY

Attendance days required (minimum 2 days): *

Monday

Tuesday

Wednesday

Thursday

Friday

Are these days flexible? *

Yes

No

Requested Room: *

Rosella Room 2-3 years

Sugar Glider Room 3-4 years

Green Tree Frog Room 3.5-5 years

DECLARATION *

I /We hereby request that the above named applicant be admitted to The Ponds Early Learning Centre Wait List. I/We have read the Procedure for Admission to the Wait List provided with this application for enrolment and by completing this form consent to this written agreement with The Ponds Early Learning Centre. I/We understand that enrolments are offered equitably with each enrolment being assessed through an application and interview/orientation process conducted by the Director or delegated ELC educator. Centre visits/tours are conducted by appointment only pending the availability of placements at the centre. I/We understand that the centre implements fixed attendance patterns to ensure equal access to care across the week, as indicated below: -2 day placements to be offered primarily on a Monday/Tuesday -3 day placements to be offered primarily on a Wednesday/Thursday /Friday -Any reductions from a 4/5 day placement throughout the year will need to adopt the 2 or 3 set days as indicated above.

I accept the above declaration.

Date Form was Completed: *

MM

DD

YYYY