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4 Castro Way

Derrimut VIC 3030

France

87-89 Ringwood Street,

RINGWOOD VIC 3134

France

Enquiry Forms

CHILD'S DETAILS

Child's Name

Child's First Name * Text value required

Middle Name * Text value required

Surname

Child's customer registration number (CRN)

Home Address

Postcode

Date of Birth

Gender

Is the child of Aboriginal and/or Torres Strait Islander origin? (Please Tick) No, not Aboriginal or Torres Strait IslanderYes, Aboriginal and Torres Strait IslanderYes, AboriginalYes, Torres Strait Islander

Does the child have a developmental delay or disability including intellectual, sensory or physical impairment? * YesNo (please Tick) Checkbox mandatory

Country of Birth

Language(s) spoken at home

Religion

Booking information

Proposed start date

Age of your child proposed start date

Days required MondayTuesdayWednesdayThursdayFriday

DETAILS FOR THE CHILD'S LEGAL PARENTS OR GUARDIANS 1 (WHICH PARENT CHILD IS UNDER WITH CENTRELINK)

First Name * Text value required

Date of birth

Relationship to the child * Text value required

Parent customer reference number (CRN)

Address

Home phone

Mobile

Employer name

Work Number

Occupation

Email (IN CAPS)

Nationality

Religion

Language spoken

Marital status

Country of birth

DETAILS FOR THE CHILD'S LEGAL PARENTS OR GUARDIANS 2

Full Name

Date of birth

Relationship to the child

Parent customer reference number (CRN)

Address

Home phone

Employer name

Occupation

Email (IN CAPS)

Nationality

Language spoken

Marital status

Mobile

Work Number

By submitting this form, I accept that the information entered will be used within the strict framework of my request* Checkbox mandatory

*These fields are mandatory

Loni Family Trust Pty Ltd is committed to ensuring that the collection and processing of data carried out by our swanchildcare.com.au site complies with the General Data Protection Regulations (GDPR) and the Data Protection Act. To know and exercise your rights, particularly concerning the withdrawal of consent to the use of collected data, please consult our privacy policy

4 Castro Way

Derrimut VIC 3030

France

87-89 Ringwood Street,

RINGWOOD VIC 3134

France

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