Hours
7am - 5:45pm

Wait List Application Form

Fields marked with an * are required

Please complete the form below to put your child on our waiting list. All applications require the payment of a $20 fee, which is payable online at the completion of this form.

Please state your preference in number order as to which location you prefer. *

Blinkies Early Education Centre, 5 Hawkins St, New Lambton (0 – 5 yrs)
Bright Buttons Early Learning Centre, 36 Kahibah Road Waratah (0 – 5yrs)

Child's Given Name *

Child's Surname Name *

Sex *

Male
Female

Date Of Birth *

Parent 1 Given Name *

Parent 1 Surname Name *

Phone/Mobile *

Email Address *

Address *

Work Details Parent 1

Employer

Phone (Work)

Occupation

Hours Worked Per Week

Parent 2 Given Name *

Parent 2 Family Name *

Phone/Mobile *

Email Address *

Work Details Parent 2

Employer

Phone (Work)

Occupation

Hours Worked Per Week

Date from which care is required *

Hours of care required

Do you currently have childcare? *

Yes
No

Does your child have special needs? *

Yes
No

Optional Comments

I understand that at the completion of this form I will be required to make a wait list application fee of $20. *