Your Name
Email
Childs Family Name :
Bill To (Parents Name) :
Address :
City :
Postal Code :
WINZ Client # :
Childs First Name :
Age :
Date of Birth :
Sex : Boy Girl
Ethnicity :
Health & Safety Notes :
Medical Notes :
Current School Attending :
Doctors Name :
Doctors Phone Number :
WINZ : Do you require an OSCAR Subsidy? Have you changed OSCAR Centres? Has this child had a subsidy in the past month? Are you changing care hours?
First Name :
Last Name :
Relationship :
Phone Home :
Phone Work :
Phone Mobile :
Pick Up Permission :
Before School Care After School Care Holiday Programme Sick Bay Sleep Over Baby Sitting
Name of School :
Class Room Number :
School Start Time :
Date to Commence Before School Care :
Frequency : (1 off, Weekly, Fortnightly etc)
Select Days to be Enrolled : Monday Tuesday Wednesday Thursday Friday
School Finish Time :
Date to Commence After School Care :
After School Activities to attend : (please detail days & times
Date to Commence Holiday Programme :
Select Times to be Enrolled : 6:45am - 6:15pm 9:00am - 6:15pm 6:45am - 4:00pm Selected Hours
Selected Hours :
Date to Commence Sick Day :
