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 CampusEmail Telephone: +61 8 8521 2895 Facsimile: +61 8 8313 7960
* indicates required fields.
Child's Full Name:
Child's Date of Birth: (actual or expected)
Proposed Booking Details: *
Starting: * For: weeks OR until
Parent/Guardian's Full Name:
Relationship to child:
Daytime phone number:
Address No./Street
Town/Suburb
Email Address:
Are you: Please tick one or more
Other Parent/Guardian's Full Name
Other Parent/Guardian is:
I wish to apply for placement as detailed above at the Roseworthy Campus Children's 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.
