Please Note: Completion of this document does not guarantee placement

Name of parent/guardian:

Address:

Phone Number:

Email Address:

Does your child have any special needs:

Reason For Care:

	A child at risk of serious abuse or neglect
	A child of a single parent who satisfies, or of parents who both satisfy, the Work / training / study test under section 14 of the Family Assistance Act
	Other child, parent at home, child socialization

Please complete both the Mother's and Father's work/study details fully. Incomplete application forms will be classified as Priority 3.

Mother's work/course address:	Phone Number:
Father's work/course address:	Phone Number:

Please click the days of care required:

Date child care needs to commence:

To register your interest in a place at Subicare it is necessary for all applicants to pay a $50 registration fee. This fee is payable upon submitting a registration of interest form. No Registration of interest form can be accepted and placed on the waiting list until the registration fee is paid.

The registration fee will be payable via electronic banking or cheque only. If a family remove their application for care before they are offered a place at our centre then Subicare will refund your $50 registration fee.

When you make your bank transfer please clearly indicate your family name as noted on your Registration of Interest form so that we will be able to match this payment to your Registration of Interest form.

Our bank details are
Subicare Child Care Centre Inc.
Westpac, Subiaco
BSB 036-051 Account Number 24-6427

Thank you for your interest