Elfin House Community Childcare Inc
Note: A place on our waiting list does not guarantee a position at the service.
Child's name *
Preferred Days *
Are you flexible with the days selected above?
Enter phone number
Does your child have a disability, speech delay, additional need (i.e. behavioural concerns)
Does your child speak English?
Any children in your family who have/or are attending our service?
Is your child of Aboriginal /Torres Strait Islander descent and recognised as such by the community?
Any further information which may be of assistance:
Children who are not vaccinated or have not provided vaccination records may be excluded in the event of a vaccine preventable disease. Is your child's immunisation up to date?
Please notify us immediately if any of the above information changes in any way. (Failure to do so may result in loss of position on waiting list). We have a firm commitment to protecting the privacy of our clients. Personal information collected on this form is for the purpose of contact and establishing priority of access only.
132 Elphinstone Street Berserker QLD 4701
(07) 4928 3944