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)?*

Adventure Patch was previously known as Blackmans Bay Childrens Services

If yes, which service?*

Have you spoken to anyone at the service about this enrolment and availability? *

Were you asked to complete this form to go onto our wait list for future availability?*

Which service do you wish to enrol in?*

Outside School Hours Care Bookings Required

Long Day Care Bookings Required

Further Comments Regarding Bookings:

Requested Start Date

Date