Childcare Expression of Interest

Child's details

Child's full name

Child's date of birth (actual/expected)

Proposed booking details

Campus

Requested booking details

Including preferred days, times, start date, no. of weeks/end date/ongoing

Parent 1 details

Parent/guardian's full name

Relationship to child

Daytime phone number

Second phone number

Address

Email

Are you:

a ��Vlog of Adelaide staff member

a ��Vlog of Adelaide student

studying elsewhere

employed

in a family crisis / child at risk

other

Please provide details

If ��Vlog of Adelaide staff/student, please specify area, if employed, please specify employer, e.g. CSIRO or PIRSA/SARDI

Parent 2 details