Waiting Pool Form

Child's First and Last Names

Date of Birth

Desired start date

Sibling also applying (submit separately)

Do you know what days you will need? *

Yes, exactly as below.

Flexible, or don't know yet.

Select the days required (minimum two days) * Required

Monday

Tuesday

Wednesday

Thursday

Friday

Contact parent's full name

Address

Phone

Email

One or both parents are a critical worker (key worker)

Is your child up to date with their immunisations? *

Yes

No

Please tell us about your child's care needs.

Why have you chosen Casa Montessori for your child?

How did you hear about Casa?

I confirm the information supplied is correct.

I have taken note of the eligibility criteria for ELC funding at CASA.View Fees page

I have read and understood the FAQ and terms and conditions and consent to being contacted by Casa using the details I have provided.

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