Waiting List Application Please complete the form below if you wish to be added to the waiting list at either Cooinda or Flynn Centres. Child(ren) DetailsHow many children are you applying for?*123Child 1 DetailsName* First Last D.O.B* Sex*MaleFemaleChild 2 DetailsName* First Last D.O.B* Sex*MaleFemaleChild 3 DetailsName* First Last D.O.B* Sex*MaleFemaleEnrolling Parent DetailsNote – the enrolling parent / guardian is responsible for all fee payments. Childcare fees are due, and payable, in full each fortnight.Name* First Last Address* Street Address City State Post Code Home PhoneWork PhoneMobile*Email* Care RequirementsPreferred Location*EitherCooindaFlynnFull Time / Part Time*Full Time (5 days per week)Part Time (less than 5 days per week)Which days* Monday Tuesday Wednesday Thursday Friday Care to Start (Date)* I give permission for the information on this form to be shared between Flynn ECEC and Cooinda Cottage*YesNoFLEXBILITY OPTIONS: Do you want to be contacted if we can offer other options e.g. different days or fewer days per week?*YesNoSIBLINGS: Do you have any other children already at this centre?*NoYesName(s) of sibling(s) at the centre*You are required to contact the centre by telephone or email every 3 months in order to maintain your place on the Waiting List.* I acknowledge that if contact is not made with the centre every 3 months, this Waiting List Application will be discarded and my place on the Waiting List will be lost. PhoneThis field is for validation purposes and should be left unchanged.