Family Day Care - Parent enquiry

Following receipt of your enquiry a Family Day Care team member will contact you and will begin to seek a placement for you.

Please note:

Only complete this form if your start date is in the next 3 months
Completing this form does not guarantee placement.

Your details

Name

Address

Phone

Mobile

Reason for care

Working/seeking work/studying
Respite/social
Other

Other reason for care

Is your place of employment within the City of Greater Geelong?

The service will seek care between your home address and the suburb you work in.

Yes
No

Suburb of work

If care is not available in this area, or you require care in another area, please list suburbs you are willing to travel to.

Child details

Please use the Add Child details button for each additional child.

Name

Date of birth

Open the calendar popup.

Gender

Female
Male

Select the days care is required

Times required on Mondays

Times required on Tuesdays

Times required on Wednesdays

Times required on Thursdays

Times required on Fridays

Times required on Saturdays

Times required on Sundays

Are you flexible about these care times?

Yes
No

Name of School or Kindergarten

Kindergarten session days and times

Does this child have any additional needs?

Needs may include Asthma, Anaphylaxis, allergies, or any other medical condition.

Yes
No

Do you required your child to be pick up or drop off at kindergarten/school?

Yes
No

Please provide details of child's additional needs

Care required from date

Your start date should be in the next 3 months.

Open the calendar popup.

Please use the Add Child details button for each additional child.

Are you requesting a placement with a particular educator?

Yes
No

Name of educator

Are you interested in shared care?

Your child would attend two Educators if all of your requested days are not available.

Yes
No

Other information

How did you hear about us?

Name of newspaper / newsletter / magazine

Name of website

Other

You hereby declare that the information provided on this form is true and correct in every respect.

Your Privacy

The City of Greater Geelong (The City) considers that the responsible handling of personal information is a key aspect of democratic governance, and is strongly committed to protecting an individual's right to privacy.

The City will comply with the Information Privacy Principles as set out in the Information Privacy Act, 2000.

The personal information required on forms will only be used by the City for the purpose of provision of Education and Care Early Years' services.

The information will not be disclosed to any other party unless the City is required to do so by law. You can view and change the information by contacting your Education and Care Service.

You agree

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We Acknowledge the Wadawurrung People as the Traditional Owners of the Land, Waterways and Skies. We pay our respects to their Elders, past, present and emerging. We Acknowledge all Aboriginal and Torres Strait Islander people who are part of our Greater Geelong community today.

Family Day Care - Parent enquiry

Your details

Child details

Other information

Your Privacy

Privacy policy

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