Waitlist Form

River Street Early Learning Centre Note: A place on our waiting list does not guarantee a position at the service. Child's name *

Gender*

Female Male TBC

Date*

Preferred Days *

Monday Tuesday Wednesday Thursday Friday

Are you flexible with the days selected above?

Yes No

Parent/Carer's Name

Enter phone number

Address

Does your child have a disability, speech delay, additional need (i.e. behavioural concerns)

Comments :

Does your child speak English?

Languages :

Any children in your family who have/or are attending our service?

Name(s) :

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.

Address 269-271 River Street Greenhill NSW 2440

Phone # 02 6562 5772

Email director@riverstreetearlylearning.com.au

Privacy Disclaimer We acknowledge and respect the privacy of our clients. By completing this form, you have consented to this information being collected. You have the right to access and alter personal information concerning yourself or your child in accordance with the Privacy Act 1988 and our Privacy and Confidentiality Policy.