Please fill in all the fields below, we may not be able to process your application if there is information missing.

Childcare Application Form
Which care are you applying for?
Your Name
Your Name

Child(ren) Details

Child Name
Child Name
Please indicate which days that are required for this child
Monday Start
Monday Finish
Tuesday Start
Tuesday Finish
Wednesday Start
Wednesday Finish
Thursday Start
Thursday Finish
Friday Start
Friday Finish
Saturday Start
Satruday Finish
Sunday Start
Sunday Finish
Reason for care?
Serious and/or complex health needs will require a Health Management Plan completed & signed by a Doctor.
Where did you hear about Northern Rivers Children's Services?
Please specify where else you have heard about Northern Rivers Children's Services