EmailMe Form - 2022 APPLICATION FORM

2022 APPLICATION FORM

Information regarding our 2022 application process:
FEES:
Session fees are:

$66.50 per 5 hour session and
$80.00 per 6 hour session

from Term 1 2022 for all term bookings.

Up to 5 days of care per week can be provided per child.

Our Sessions operate from
9.00am - 2.00pm - Monday, Wednesday and Friday
9.00am - 3.00pm - Tuesday and Thursday .

Our terms run in accordance with Victorian school terms and we are closed during all school holiday periods.

All fees are due in advance for the term ahead prior to commencement of any sessions.

For Further information regarding fees please refer to our updated fee policy here:

FEES POLICY

APPLICATION PROCESS: Please complete the following application form without delay in order to secure a place on your preferred day/s. You will be notified as soon as possible of acceptance based on availability.

IMMUNISATION: Please note that all children must be fully immunised for their age. Proof of Immunisation will be required.
APPLICATION FEE - TERMS AND CONDITIONS
• An application fee of:

$133.00 each 5 hour session selected or
$160.00 each 6 hour session selected

is payable when submitting an application for your child for 2022

• This application fee will be deducted from your term fee invoice

• THIS APPLICATION FEE IS NOT REFUNDABLE, unless we are unable to offer you a place on day or days requested.

• Applications will be accepted, and enrolments made, in order of date form AND payment are received.

PLEASE NOTE: No enrolment will be processed until the application fee has been paid.

• Payment can be made by bank deposit or internet transfer only to:
North Balwyn Playcentre
BSB: 063155
Account Number: 10019760

Please use your surname and 2022 as your payment reference. Eg.(CITIZEN2022)
Q.1. Parent First Name *
Parent Last Name *
Q.2. Parent Date Of Birth (This is a Government Requirement for Enrolment) *
DD / MM / YYYY
Q.3. Address *

Street Address City State / Province / Region Postal / Zip Code
Q.4.Mobile Phone Number *
### - ### - ####
Q.5. Email Address *
Q.6. Are you registered for Child Care Subsidy(if yes please complete question 7) *
Q.7. Parent Customer Reference Number (for Child Care Subsidy)
Information for Child One
Please complete questions 8-14
8. Child 1 First Name *
Child 1 Last Name *
Q.9. Child 1 Date of Birth *
DD / MM / YYYY
Q.10. Child 1 Customer Reference Number (for Child Care Subsidy)
Q.11. How Many Days of Care would you like for CHILD 1? *
1
2
3
4
5
Q.12. Session 1 - What day would you like?
If your preferred day is unavailable please complete our WAITING LIST
Form *
Q.13. Session 2 - What day would you like? (Please select No Care if a Second day is not required) *
Q.14. Session 3 - What day would you like? (Please select No Care if a Third day is not required) *
Q.15. Session 4 - What day would you like? (Please select No Care if a Fourth day is not required) *
Q.16. Session 5 - What day would you like? (Please select No Care if a Fifth day is not required) *
Q.17.Tell Us About Child 1: Please help us to provide the best possible introduction to our program by providing information about any
SPECIAL NEEDS, Interests, Relevant Medical Information, Fears etc. *
Q.18. Do you wish to apply for a place for any other children? If Yes, Please complete details below.... *
No - Please go to Question 31
Yes
Information for Child Two

(Please complete only if you are applying for a place for a second child)
Q.19. Child 2 First Name
Child 2 Last Name
Q.20. Child 2 Date of Birth
DD / MM / YYYY
Q.21. Child 2 Customer Reference Number (for Child Care Subsidy)
Q.22. How Many Days of Care would you like for CHILD 2?
1
2
3
4
5
Q.23. Session 1 - What day would you like?
If your preferred day is unavailable please complete our WAITING LIST
Form
Q.24. Session 2 - What day would you like? (Please select No Care if a Second day is not required)
Q.25. Session 3 - What day would you like? (Please select No Care if a Third day is not required)
Q.26. Session 4 - What day would you like? (Please select No Care if a Fourth day is not required)
Q.27. Session 5 - What day would you like? (Please select No Care if a Fifth day is not required)
Q.28.Tell Us About Child 2: Tell Us About Child 1: Please help us to provide the best possible introduction to our program by providing information about any
SPECIAL NEEDS, Interests, Relevant Medical Information, Fears etc.
Q.29. Do you wish to apply for a place for any other children? If Yes, Please complete details below....
No - Please go to Question 31
Yes
Q.30. Details for Child 3:
Please include
1. Child's Full Name,
2. Date Of Birth,
3. Days Required,
4. Customer Reference Number for Child 3.
5. Information about Child 3 - Special Needs? Interests? Relevant Medical Information? Fears?
DEPOSIT REQUIRED
A deposit is required with this application form. No application form can be processed without this.

This deposit is refundable only if your nominated day or days are unavailable. This deposit will be credited to your account and will be used towards your fees account for the term.

Please CLICK HERE to calculate the total deposit payable.
TOTAL DEPOSIT FOR ALL SESSIONS (ALL CHILDREN) *
$ Dollars . Cents
BANKING DETAILS FOR DEPOSIT
Your deposit can be made via internet banking or at any branch of the Commonwealth Bank. Please use your Surname and 2022 (i.e. CITIZEN2022) as the reference when making this payment. (please enter reference used for your payment in box below)

ACCOUNT NAME: North Balwyn Playcentre

BSB: 063155

ACCOUNT NUMBER: 10019760
Date Deposit Paid *
DD / MM / YYYY
Please upload a copy of your deposit receipt here.

Please note your form cannot be processed without this deposit. *
Agree to the Application Terms and Conditions

Please read our APPLICATION TERMS AND CONDITIONS Here *
YES
Click the above if you a have read and agree to the Terms and Conditions as outlined in the TERMS AND CONDITIONS information above