Expression of Interest
Parent/Guardian's Full Name
*
Phone Number
*
Email Address
*
Child's Name
*
Child's Date of Birth
*
Reason for care
*
Have you previously used, or are you currently using our service (for this child)?
*
Yes
No
Unsure
Adventure Patch was previously known as Blackmans Bay Childrens Services
If yes, which service?
*
Mountain View Long Day Care
Ocean View Long Day Care
Roland View Long Day Care
Blackmans Bay Outside School Hours Care
Campania Outside School Hours Care
Dunalley Outside School Hours Care
Eastside Lutheran College Outside School Hours Care
Illawarra Outside School Hours Care
Kingston Outside School Hours Care
New Town Outside School Hours Care
St. Aloysius Outside School Hours Care
Channel Christian School Outside School Hours Care
Lilydale Outside School Hours Care
Have you spoken to anyone at the service about this enrolment and availability?
*
Yes
No
Were you asked to complete this form to go onto our wait list for future availability?
*
Which service do you wish to enrol in?
*
Mountain View Long Day Care
Ocean View Long Day Care
Roland View
Blackmans Bay Outside School Hours Care
Kingston Outside School Hours Care
Illawarra Outside School Hours Care
New Town Outside School Hours Care
St. Aloysius Outside School Hours Care
Eastside Lutheran College Outside School Hours Care
Dunalley Outside School Hours Care
Campania Outside School Hours Care
Channel Christian School Outside School Hours Care
Lilydale Outside School Hours Care
Calvin Christian School Outside School Hours Care
Outside School Hours Care Bookings Required
Monday
Tuesday
Wednesday
Thursday
Friday
Before School Care
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
After School Care
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Vacation Care
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Long Day Care Bookings Required
Monday
Tuesday
Wednesday
Thursday
Friday
Morning Session
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Afternoon Session
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Full Day
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Further Comments Regarding Bookings:
Requested Start Date
-
Day
-
Month
Year
Date
Submit
Should be Empty: