(Text) General Information Heading

CHILD DETAILS

Child's family name

Child's first name

Child's Date of Birth / expected date of birth

Child's residential address

Postcode

(Text) Carer Details Heading

PARENT/CARER DETAILS

(Text) Parent/Carer 1

Parent/Carer 1

Family name

First name

Residential address

Postcode

Contact number

Please provide your home/mobile number

What is your relationship to the child?

(Text) Carer 2 heading

Parent/Carer 2

Family name

First name

Residential address

Postcode

Contact number

What is your relationship to the child?

(Text) Enrolment Preferences

ENROLMENT PREFERENCES

Preferred commencement date

Any other comments

(Text) Additional Information

ADDITIONAL INFORMATION

(Text) additional information explanation

(This information is collected to determine priority of access according to Government Legislation and operational policy)

Please provide details

NDIS plan/number

If you have an NDIS plan/number, please provide

(Text) Commonwealth Bank Heading

Commonwealth Bank – additional information to assist in determining priority of access

(Text) Commonwealth Sub Heading

For Employees of the Commonwealth Bank Group ONLY

(Text) Common Bank Instructions

If you are an employee of the Commonwealth bank Group, please complete section ‘for employees of the Commonwealth Bank Group’ below.

If answered ‘none of the above’, what is the current employment status of Parent/Carer No.1?

Which of the following applies to you?

Please tick all that apply

Requiring care as you do not have permanent childcare arrangements in place Requiring care for a grandchild who does not have permanent childcare arrangements in place Have another child/children occupying a place within the centre Have another child/children occupying a place within a CBA KU Managed centre Returning from parental leave

Add me to waiting list

Your selected centre(s)

Please complete the following form