Waitlist Form

City of Newcastle acknowledges that we operate on the grounds of the traditional country of the Awabakal and Worimi peoples.
We recognise and respect their cultural heritage, beliefs and continuing relationship with the land, and that they are the proud survivors of more than two hundred years of dispossession.
CN reiterates its commitment to address disadvantages and attain justice for Aboriginal and Torres Strait Islander peoples of this community.

Childs details
Name*:
Date of birth:
Years:
Months:
Sex:	Male Female
Is your child toilet trained:	Yes No
Reason for care:
Parents / guardian details
Name of Parent 1*:
Contact number *:
Email address:
Postal address:
Name of Parent 2*:
Contact Number:
Email address:
Postal address (if different from above):
Care needs
Days:	Monday Tuesday Wednesday Thursday Friday Please select the days you would like your child to attend the centre.
Hours:	What hours do you require care for? eg 9am - 3:30pm
Date you require care from:	Today
Are your chosen days flexible?:	Yes No
Concerns:	Does you child have special needs or is there any particular area that concerns you? e.g. Speech or ADD
How did you hear about us: