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BLACKMANS BAY CHILDRENS SERVICES
WAITING LIST APPLICATION
Date of Application: _______/_______/_______
Reason for Care: ________________________________________________________________
Parents Names: _________________________________________________________________
Child's Name: _______________________________ Date of Birth:_______________
Address: ______________________________________________________________
__________________________________________________________________________
Home Phone: ____________________________
Work Phone: _____________________________
Mobile: ____________________________
Service Required: Ocean View Child Care Centre Blackmans Bay Mountain View Child Care Centre Kingston Before School Care Blackmans Bay / Illawarra / Kingston After School Care Blackmans Bay / Illawarra / Kingston / St Aloysius
BOOKINGS REQUIRED Start Date:_________________ (please circle)
Monday am pm Full
Tuesday am pm Full
Wednesday am pm Full
Thursday am pm Full
Friday am pm Full
Renewal Dates (staff only)
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