81-83 Correys Ave, Concord      (02) 9739 6960

Enrol At Cubby CollegeĀ Child Care Centre Now!

To secure a place on our Cubby College Waitlist it is mandatory that the following steps are completed:

  • Non-refundable administration fee is paid on site
  • Original copy of Child's birth certificate is sighted
  • Copies of Child's birth certificate and immunisation history are provided

Note: due to the unpredictable nature of Long Day Care waiting lists, the centre can make no guarantees that a placement will be available when you require care, nor can we provide estimated times when positions will be offered.

If you have any further questions, make sure you check out our FAQ page, or get in touch with us.


CHILD DETAILS:

Requested date to start: dd/mm/yyyy

Child's surname: *

Given name(s) *:

Former name/s or any other names in which child is known by:

D.O.B: dd/mm/yyyy

Gender M / F:
MF

Address:

Place of Birth:

Cultural Background:

Position in the family (e.g. 1st Child):

Is your child of Aboriginal or Torres Strait Islander descent?
YesNo

Child's CRN:


REQUESTED DAYS OF ATTENDANCE:

Please enter estimated arrival and departure times:

Monday
Arrival Time

Departure Time

Tuesday
Arrival Time

Departure Time

Wednesday
Arrival Time

Departure Time

Thursday
Arrival Time

Departure Time

Friday
Arrival Time

Departure Time


MOTHER, PARENT, GUARDIAN or CARER DETAILS:

Parent 1 surname:

Given name:

Former name/s or any other names in which Parent 1 is known by:

Occupation:

Address:

Home number:

Work number:

Mobile number:

Email: *

Parent CRN:

Date of Birth: dd/mm/yyyy


FATHER, PARENT, GUARDIAN or CARER DETAILS:

Parent 2 surname:

Given name:

Former name/s or any other names in which Parent 2 is known by:

Occupation:

Address:

Home number:

Work number:

Mobile number:

Email:

Parent CRN:

Date of Birth: dd/mm/yyyy


MEDICAL DETAILS:

Medicare Number:

Do you have Ambulance Cover?
YesNo

Do you have Private Health?
YesNo

Fund Name:

Fund Number:

Doctor's Name:

Doctor's Phone Number:

Doctor's Address:

Dentist's Name:

Dentist's Phone Number:

Dentist's Address:


IMMUNISATION DETAILS:

Are your child's immunisations up to date?
YesNo

* Please provide a copy of your child's Australian Childhood Immunisation Records (ACIR) Statement. (You can get a copy by calling 1800 653 809, by email on acir@medicareaustralia.gov.au, from a Medicare or Centrelink office or online at www.medicareaustralia.gov.au/online.)

If your child's immunisations are not up to date, please attach one of the following documents:

  • A current ACIR Immunisation History Form on which the doctor has certified the child in on an approved catch-up schedule.
  • An ACIR Immunisation Exemption- Medical Contraindication Form signed by a doctor
  • An ACIR Immunisation Exemption- Conscientious Objection Form signed by a doctor. These forms are available from www.humanservices.gov.au Please note Child Care Benefit cannot be claimed for Conscientious objection.

Upload Immunisation document *
In pdf, doc, docx file format only. Max file size is 2MB


SPECIFIC HEALTH CARE NEEDS:

Does your child have any specific health care needs or medical conditions e.g. asthma, allergies, anaphylaxis, diabetes?
YesNo

If yes, please provide details:

* If yes, please provide a Medical Management Plan for your child (these are prepared and signed by the child's doctor). The Plan should cover what triggers the medical condition or allergy, first aid needed, doctor's contact details, plan review date and also include a photo of your child.


DIET:

Does your child have any dietary restriction that you have not already mentioned?
YesNo

If yes, please provide details:


ADDITIONAL NEEDS:

Has your child been diagnosed with any special needs or learning difficulties?
YesNo

If yes, Please provide details:


AUTHORISED EMERGENCY CONTACTS:

Do you authorise the Approved Provider, Nominated Supervisor or an educator to seek medical treatment for your child from a registered practitioner (including dentist, hospital or ambulance service) and/or to transport your child by ambulance in an emergency?

Parent 1:
YesNo

Parent 2:
YesNo


CONTACT ONE:

Surname:

Given name(s):

Address:

Home number:

Work number:

Mobile number:

Relationship to child:

I authorise this person to collect my child from your service:
YesNo

Can we notify this person of any emergency involving your child if we cannot immediately contact you?
YesNo

Can this person consent to medical treatment or the administration of medication if we cannot contact you?
YesNo

Can this person consent to the Nominated Supervisor or an educator taking the child outside the service if we cannot contact you?
YesNo


CONTACT TWO:

Surname:

Given name(s):

Address:

Home number:

Work number:

Mobile number:

Relationship to child:

I authorise this person to collect my child from your service:
YesNo

Can we notify this person of any emergency involving your child if we cannot immediately contact you?
YesNo

Can this person consent to medical treatment or the administration of medication if we cannot contact you?
YesNo

Can this person consent to the Nominated Supervisor or an educator taking the child outside the service if we cannot contact you?
YesNo


COURT ORDERS:

Are there any court order, parenting orders or parenting plans covering the powers, duties, responsibilities or authorities of any person in relation to the child or access to the child?
YesNo

If yes, please attach documents.

In pdf, doc, docx file format only. Max file size is 2MB


PHOTOGRAPHY

I consent to:

  • My child being photographed by educators and staff members of Cubby College for educational purposes or to support their medical documentation.
  • My child being photographed by other individuals using the service including school photographers, individuals undertaking research projects, students on practicum placement and services that undertake extra curriculum activities within the Cubby College.
  • The photographs taken by educators and staff members being used to publicise Cubby College or to inform Cubby College families about what is happening at the service. This may include posting the photographs on Cubby College website or including them in services brochures and media articles.
  • The posting of photographs taken by educators and staff members on Cubby College's social media account in a closed group.

I understand I can withdraw my consent about the taking of photographs of my child at any time by advising the Nominated Supervisor in writing.

Parent One:
YesNo

Parent Two:
YesNo


ADMINISTRATION FEE:

Your application is subject to payment of the waiting list fee. Cash payments will be accepted on specified days, Cubby College Child Care will notify parents/carers of the time and location. Payment must be made before you are placed on the waiting list. Once paid, your Child's name will be placed on the waiting list & you will be advised when a position becomes available.

Please notify the Director of the Centre of any changes to your application. This includes your address, phone number etc.


chld enrolled at cubby college child care centre

Ready to find out more?

Drop us a line today for more information!