prospective carer 'first request' form

Please enter today's Date:       

    How did you learn about Bayside family day care?
     
  
at least one selection is required

                       
  
    Hold CTRL key and click to select multiple choices

       if 'other', please specify
             

If 'Newspaper', please specify which newspaper

     

     Basic Contact Details (required)

Name
Email
Address

SUBURB

 

Postcode 

     

State

Telephone Home
Mobile
Work
   

PRELIMINARY BACKGROUND QUESTIONS

   Number of your own children:    

 Boys       Ages    

Girls       Ages

 

 Do you own a car?

Yes  No 

If Yes:

Make/Model  

Registration  

Number of Seats in Car 

 

your Housing Arrangements: 

Own     Rent

Does your residence have its own yard

  Yes       No

Is your yard fenced?

Yes          No

 

Animals:

do you have animals at home ?   Yes  No


Type(s) of animals
 

Hold CTRL key and click to select multiple choices

 

Number of Animals  

 If 'other' type of animals, please specify 

How you separate animals from children:

 

What if any previous child care qualifications do you have?

What if any previous child care experience do you have?

What specific Knowledge of Family Day Care do you have?

Are you Currently Employed? Yes    No

If Yes, what is your current employment status:

Describe your current position:

please enter any additional Comments you wish us to consider: