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
Tamar Valley Child Care
Blackmans Bay Outside School Hours Care
Calvin Outside School Hours Care
Channel Outside School Hours Care
Illawarra Outside School Hours Care
Kingston Outside School Hours Care
Mount Stuart Outside School Hours Care
New Town Outside School Hours Care
Snug Outside School Hour Care
St. Aloysius Outside School Hours Care
Dunalley OSHC
Campania OSHC
Eastside OSHC
Lilydale OSHC
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 Long Day Care
Tamar Valley Childcare
Blackmans Bay Outside School Hours Care
Calvin Outside School Hours Care
Channel Outside School Hours Care
Illawarra Outside School Hours Care
Kingston Outside School Hours Care
Mount Stuart Outside School Hours Care
New Town Outside School Hours Care
Snug Outside School Hours Care
St. Aloysius Outside School Hours Care
Outside School Hours Care Bookings Required
Rows
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
Rows
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
2 digit day, 2 digit month, 4 digit year
Date
Submit
Should be Empty: