Request Child Care

This is your first point of contact with our Service. Complete and submit this form to let us know a little bit about you, and to outline when you need childcare. We will follow up! Your information is secure, private, and held in strict confidence.

Today's Date * / MM / DD YYYY
So we can track your date and time of entry into our system, and so we can monitor the efficiency of our response time.
We just have to know precisely HOW you learned about Bayside Family Day Care! * Newspaper Advertisement Google Search Online Brochure or Flyer Word of Mouth Yellow Pages Radio Ad on BAY FM Other
Exact Keywords You Used to Search
[Enter 'NA' if not applicable] *
If Newspaper, please specify precisely which one
[Enter' NA' for not applicable] *
Your Name * Title First Last Suffix
Your Email Address *
Residential Telephone Number *
Mobile Phone Number *
Work Telephone

We do not require this number at this moment, but if you proceed to place a child in our care then it will be important information for us to have so that we can reach you while your child is in care.
Your Address including your specific suburb *
Street Address

Address Line 2

Suburb

State

Post Code

Country
PRIORITY OF ACCESS
Please select: * First Priority -- Child at Risk of Serious Abuse or Neglect Second Priority -- A child of a single parent who satisfies, or of parents who satisfy the work/training/study test under Section 14 of FAO Act Third Priority -- Any other Child
DATE AND TIME YOUR CHILDCARE NEEDS TO COMMENCE
Date your childcare needs to commence * / DD / MM YYYY
Is transport required? * Yes No
Does your child attend another child care service? * Yes No
Enter NAME of that service *
Pre/School attended
BASIC INFORMATION ABOUT CHILD/REN
NAME of Child 1 * First Last
Child 1 Date of Birth * / DD / MM YYYY
NAME of Child 2 First Last
Child 2 Date of Birth / DD / MM YYYY
NAME of Child 3 First Last
CHild 3 Date of Birth / MM / DD YYYY
PLEASE ENTER DAYS and HOURS OF CARE THAT YOU REQUIRE

The fee charged is based on the booked hours only.
Days and Hours of Care Required *
EXAMPLE: Monday, 7:00am to 4:00pm, Wednesday 7:30am to 3:30pm, Friday 8:00am to 4:30pm [now please enter your own data below]:
Any Additional Comments or Questions?
SIGNATURE and SUBMISSION

By signing and submitting this form I am requesting that Bayside Family Day Care determine whether a Family Day Care Provider with the Service can care for my children.
NAME of PARENT/GUARDIAN * Title First Last Suffix
SECURITY FEATURE

The security feature below protects your privacy by assuring that your email address and private information are protected. If you have difficulty, use the little arrow at right to request another display or an audio message you can enter.

Request Child Care

Request Child Care

PRIORITY OF ACCESS

DATE AND TIME YOUR CHILDCARE NEEDS TO COMMENCE

BASIC INFORMATION ABOUT CHILD/REN

PLEASE ENTER DAYS and HOURS OF CARE THAT YOU REQUIRE

SIGNATURE and SUBMISSION

SECURITY FEATURE