Apply

If you would like to apply for a place at our Centre, please read the general information on enrolment , the Waiting List & Enrolment Policy and the fine print. Note that due to high demand, your application only guarantees you a place on our waiting list.

*asterisk indicates compulsory fields

Details of Child

First name(s)*

Family name*

Date of Birth*
(e.g. 15-Sep-2008)
Gender*
 Female Male
Days required*
 Mon Tues Wed Thurs Fri
Any other relevant information


Preferred starting date*
(e.g. 03-Apr-2011)

Details of Parent(s)

Parent A
(Correspondence related to this application will be directed to "Parent A")

First name(s)*

Family name*

Home address*


Gender*
 Female Male
Phone (home)*

Phone (work)

Phone (mobile)*

Email address*

Place of work/study*

Parent B

First name(s)

Family name

Home address

Gender
 Female Male
Phone (home)

Phone (work)

Phone (mobile)

Email

Place of work/study

Additional Information

Do you have other children attending UPCCC?  No Yes
    If so, please note their name(s) here:
Does 'Parent A' work or study at ANU?  No Yes
If so, please add your ANU ID # here:
Does 'Parent B' work or study at ANU?  No Yes
If so, please add your ANU ID # here:
Are you a single parent?  No Yes


Please note the following:

  • That our acceptance of this form does not constitute a contract to provide a place at the Centre.
  • Once accepted onto our waiting list, your child’s name will be active for a period of 3 months. If you have not secured a place within this time, you will need to contact the Centre to advise your intention to remain on the waiting list or your child’s name will be deleted.
  • You should contact the Centre if your care requirements or circumstances change.
  • All information in this form is confidential and for Centre use only.
  • Part-time care will only be offered for 2 or 3 contiguous days a week commencing Monday or Wed/Thurs (i.e. part-time care offered from Mon-Tues/Wed or Wed/Thurs-Fri).

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