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Child Care Services
The University of Adelaide
SA 5005
AUSTRALIA

Adelaide Campus
Email
Telephone: +61 8 8313 5429
Facsimile: +61 8 8313 4404.

Waite Campus
Email
Telephone: +61 8 8313 6560
Facsimile: +61 8 8313 6561

Roseworthy Campus
Email
Telephone: +61 8 8521 2895
Facsimile: +61 8 8313 7960

Adelaide Campus Children's Centre

Childcare Expression of Interest

Child's Full Name
Child's Date of Birth * (actual or expected) Sex:
Proposed booking details *
  Mon Tue Wed Thu Fri
Arrive:
Depart:
Starting * For: weeks OR until
Parent/Guardian's Full Name *
Relationship to child *
Daytime phone number * (1): (2):
Address No./Street *
Town/Suburb * Postcode:
Email Address
Are you: (Please tick one or more)
Other Parent/Guardian's Full Name
Relationship to Child
Daytime phone number (1): (2):
Other Parent/Guardian is (Please tick one or more)

* = details required for this field

I wish to apply for placement as detailed above at the Adelaide Campus Childrens Centre.

I understand that I must complete a Child Care Benefit Application form and submit it to the Family Assistance Office if I intend to claim such benefit. (CCB application forms are available at the Centre and FAO).

I understand that to maintain this place on the waiting list, I / we need to contact the Director of the Centre at least every three months to confirm our continuing interest. Not doing so will mean the deletion of this application from the waiting list.

Please press the Submit button, and the Director of the Centre will respond to you soon.