Waitlist Form

👤 Parent / Guardian Details

Parent First Name *

Parent Last Name *

Email Address *

Phone Number *

Residential Address *

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👶 Child Details

Child's First Name *

Child's Last Name *

Child's Date of Birth *

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📅 Enrolment Preferences

Preferred Start Date

Preferred Start Time *

ImmediateNext YearOther

If you selected Other, please provide details.

Preferred Days *

MondayTuesdayWednesdayThursdayFriday

How many days per week are you seeking care?
Please select1 Day2 Days3 Days4 Days5 Days

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🩺 Health and Additional Information

Does your child have any allergies? *

YesNo

If yes, please provide details.

Does your child have any diagnosed medical conditions? *

YesNo

If yes, please provide details.

Does your child have any diagnosed disabilities or any other additional needs we may need to be aware of? *

YesNo

If yes, please provide details.

Does your child require any additional language support relating to English? *

YesNo

If yes, please provide details.

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💙 Additional Information

How did you hear about Footprints?
Please selectGoogleFacebookFriend or FamilyCurrent Footprints FamilyWalking or Driving PastOther

Would you like to book a tour?

YesNo

Additional comments or information

I consent to Footprints Child Care Centre collecting and using the information provided in this form to respond to my enquiry.